Provider Demographics
NPI:1962673632
Name:4 KIDS DENTAL CENTER, P.C.
Entity Type:Organization
Organization Name:4 KIDS DENTAL CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:LUCCY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:724-837-4400
Mailing Address - Street 1:660 E PITTSBURGH ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-2677
Mailing Address - Country:US
Mailing Address - Phone:724-837-4400
Mailing Address - Fax:724-837-1613
Practice Address - Street 1:660 E PITTSBURGH ST
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-2677
Practice Address - Country:US
Practice Address - Phone:724-837-4400
Practice Address - Fax:724-837-1613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS 015320 L1223G0001X
PADS 018180 L1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007813660002Medicaid
PA0017262150001Medicaid