Provider Demographics
NPI:1679947063
Name:DENTAL PROFESSIONALS OF PENNSYLVANIA, PC
Entity Type:Organization
Organization Name:DENTAL PROFESSIONALS OF PENNSYLVANIA, PC
Other - Org Name:GREENSBURG DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING TEAM LEAD
Authorized Official - Prefix:
Authorized Official - First Name:KENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-8312
Mailing Address - Street 1:6185 STATE ROUTE 30
Mailing Address - Street 2:SUITE A
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-6408
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6185 STATE ROUTE 30
Practice Address - Street 2:SUITE A
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-6408
Practice Address - Country:US
Practice Address - Phone:724-734-5110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTAL PROFESSIONALS OF PENNSYLVANIA, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-11-23
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty