Provider Demographics
NPI:1023602265
Name:OMNI DENTAL SHADYSIDE LLC
Entity type:Organization
Organization Name:OMNI DENTAL SHADYSIDE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HANLON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:412-362-5556
Mailing Address - Street 1:3035 WASHINGTON RD STE 3
Mailing Address - Street 2:
Mailing Address - City:MC MURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317-3281
Mailing Address - Country:US
Mailing Address - Phone:412-362-5556
Mailing Address - Fax:724-909-1670
Practice Address - Street 1:202 S HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-3913
Practice Address - Country:US
Practice Address - Phone:412-362-5556
Practice Address - Fax:724-909-1670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-01
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental