Provider Demographics
NPI:1700869682
Name:NOVA DENTAL EAST SUBURBAN
Entity Type:Organization
Organization Name:NOVA DENTAL EAST SUBURBAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRETT
Authorized Official - Middle Name:M
Authorized Official - Last Name:BENDER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:412-824-8830
Mailing Address - Street 1:215 FOREST HILLS PLAZA
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15221
Mailing Address - Country:US
Mailing Address - Phone:412-824-8830
Mailing Address - Fax:412-824-0493
Practice Address - Street 1:215 FOREST HILLS PLAZA
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15221
Practice Address - Country:US
Practice Address - Phone:412-824-8830
Practice Address - Fax:412-824-0493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS019606L122300000X
PADS026612L1223S0112X
PADS025542L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered122300000XDental ProvidersDentistGroup - Single Specialty
Not Answered1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty