Provider Demographics
NPI:1013285998
Name:DENTISTRY FOR KIDS
Entity Type:Organization
Organization Name:DENTISTRY FOR KIDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERRA
Authorized Official - Middle Name:E
Authorized Official - Last Name:GREB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-772-9688
Mailing Address - Street 1:20440 ROUTE 19
Mailing Address - Street 2:
Mailing Address - City:CRANBERRY TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-7543
Mailing Address - Country:US
Mailing Address - Phone:724-772-9688
Mailing Address - Fax:
Practice Address - Street 1:20440 ROUTE 19
Practice Address - Street 2:
Practice Address - City:CRANBERRY TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:16066-7543
Practice Address - Country:US
Practice Address - Phone:724-772-9688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA26194PA122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty