Provider Demographics
NPI:1245506039
Name:PUREDENT, INC.
Entity type:Organization
Organization Name:PUREDENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:DEGREGORIO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, AIAOMT
Authorized Official - Phone:412-631-8947
Mailing Address - Street 1:580 S. AIKEN AVENUE
Mailing Address - Street 2:SUITE 620
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15232
Mailing Address - Country:US
Mailing Address - Phone:412-631-8947
Mailing Address - Fax:412-621-0624
Practice Address - Street 1:580 S. AIKEN AVENUE
Practice Address - Street 2:SUITE 621
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15232
Practice Address - Country:US
Practice Address - Phone:412-631-8947
Practice Address - Fax:412-621-0624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027253L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty