Provider Demographics
NPI:1295097442
Name:ROBERT A PETCASH DMD PC
Entity type:Organization
Organization Name:ROBERT A PETCASH DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:PETCASH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:724-444-7770
Mailing Address - Street 1:2879 W HARDIES RD
Mailing Address - Street 2:
Mailing Address - City:GIBSONIA
Mailing Address - State:PA
Mailing Address - Zip Code:15044-8203
Mailing Address - Country:US
Mailing Address - Phone:724-444-7770
Mailing Address - Fax:724-444-7676
Practice Address - Street 1:2879 W HARDIES RD
Practice Address - Street 2:
Practice Address - City:GIBSONIA
Practice Address - State:PA
Practice Address - Zip Code:15044-8203
Practice Address - Country:US
Practice Address - Phone:724-444-7770
Practice Address - Fax:724-444-7676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-13
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0277331223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU61801Medicare UPIN