Provider Demographics
NPI:1629615455
Name:FRENCH CREEK DENTAL GROUP
Entity Type:Organization
Organization Name:FRENCH CREEK DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:LUELLA
Authorized Official - Last Name:PINKERTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-664-8402
Mailing Address - Street 1:234 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SLIPPERY ROCK
Mailing Address - State:PA
Mailing Address - Zip Code:16057-1247
Mailing Address - Country:US
Mailing Address - Phone:724-664-8402
Mailing Address - Fax:724-406-0260
Practice Address - Street 1:900 WATER ST
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-3428
Practice Address - Country:US
Practice Address - Phone:724-664-8402
Practice Address - Fax:724-406-0260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-27
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty