Provider Demographics
NPI:1790814366
Name:UPMC CHILDREN'S HOSPITAL OF PITTSBURGH DENTAL PROGRAM
Entity Type:Organization
Organization Name:UPMC CHILDREN'S HOSPITAL OF PITTSBURGH DENTAL PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-692-6805
Mailing Address - Street 1:PO BOX 382007
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15251-8007
Mailing Address - Country:US
Mailing Address - Phone:412-692-5440
Mailing Address - Fax:412-692-5335
Practice Address - Street 1:3705 5TH AVE
Practice Address - Street 2:GROUND FLOOR
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213
Practice Address - Country:US
Practice Address - Phone:412-692-5440
Practice Address - Fax:412-692-5335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS016769L261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000149658OtherUCCI
PA1007347990015Medicaid