Provider Demographics
NPI:1710999339
Name:DATTILO AND HALL LLC
Entity Type:Organization
Organization Name:DATTILO AND HALL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL MAXILLOFACIAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:DATTILO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:412-563-7707
Mailing Address - Street 1:305 MOUNT LEBANON BLVD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15234-1511
Mailing Address - Country:US
Mailing Address - Phone:412-563-7707
Mailing Address - Fax:412-563-0970
Practice Address - Street 1:305 MOUNT LEBANON BLVD
Practice Address - Street 2:305
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15234-1511
Practice Address - Country:US
Practice Address - Phone:412-563-7707
Practice Address - Fax:412-563-0970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA004244Medicare ID - Type Unspecified