Provider Demographics
NPI:1912024159
Name:WEST PENN DENTAL CENTER LLC
Entity Type:Organization
Organization Name:WEST PENN DENTAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:STEINES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:412-279-7366
Mailing Address - Street 1:312 SECOND AVENUE
Mailing Address - Street 2:
Mailing Address - City:CARNEGIE
Mailing Address - State:PA
Mailing Address - Zip Code:15106-2509
Mailing Address - Country:US
Mailing Address - Phone:412-279-7366
Mailing Address - Fax:412-279-6668
Practice Address - Street 1:312 SECOND AVENUE
Practice Address - Street 2:
Practice Address - City:CARNEGIE
Practice Address - State:PA
Practice Address - Zip Code:15106-2509
Practice Address - Country:US
Practice Address - Phone:412-279-7366
Practice Address - Fax:412-279-6668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS037893122300000X
PADS025773L122300000X
PADS021038L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1022464050001Medicaid