Provider Demographics
NPI:1508263468
Name:COMPLETE FAMILY DENTISTRY
Entity Type:Organization
Organization Name:COMPLETE FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DMD
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:KRAISINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:724-244-1189
Mailing Address - Street 1:80 HUFF AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601
Mailing Address - Country:US
Mailing Address - Phone:724-836-3368
Mailing Address - Fax:724-836-1209
Practice Address - Street 1:80 HUFF AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601
Practice Address - Country:US
Practice Address - Phone:724-836-3368
Practice Address - Fax:724-836-1209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-20
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025226L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty