Provider Demographics
NPI:1497718563
Name:TRUESDELL-GHAFFARI, CATHERINE (DMD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:TRUESDELL-GHAFFARI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:926 GREAT POND DR
Mailing Address - Street 2:SUITE 2003
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-7244
Mailing Address - Country:US
Mailing Address - Phone:407-772-5124
Mailing Address - Fax:407-788-3572
Practice Address - Street 1:1955 WHARTON STREET
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15203
Practice Address - Country:US
Practice Address - Phone:412-381-0100
Practice Address - Fax:412-381-5665
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025026122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010301490002Medicaid
PA0010301490003Medicaid
PA0010301490006Medicaid
PA0010301490008Medicaid
PA0010301490019Medicaid
PA0010301490007Medicaid
PA0010301490016Medicaid
PA0010301490018Medicaid
PA0010301490010Medicaid
PA0010301490017Medicaid
PA0010301490009Medicaid
PA0010301490013Medicaid
PA0010301490015Medicaid