Provider Demographics
NPI:1548741937
Name:CRANBERRY PEDIATRIC DENTISTRY, PC
Entity Type:Organization
Organization Name:CRANBERRY PEDIATRIC DENTISTRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PRIYANKA
Authorized Official - Middle Name:
Authorized Official - Last Name:VADDI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:607-331-1020
Mailing Address - Street 1:117 MARSHALL DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15228-1789
Mailing Address - Country:US
Mailing Address - Phone:607-331-1020
Mailing Address - Fax:
Practice Address - Street 1:20421 ROUTE 19
Practice Address - Street 2:
Practice Address - City:CRANBERRY TWP
Practice Address - State:PA
Practice Address - Zip Code:16066-7513
Practice Address - Country:US
Practice Address - Phone:724-776-1228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0386991223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty