Provider Demographics
NPI:1356408405
Name:RICHARD J GOTTFRIED, DMD & MARGARET A DURACHKO, DMD, PC
Entity type:Organization
Organization Name:RICHARD J GOTTFRIED, DMD & MARGARET A DURACHKO, DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:DURACHKO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:412-931-5611
Mailing Address - Street 1:1100 CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:WEST VIEW
Mailing Address - State:PA
Mailing Address - Zip Code:15229-1636
Mailing Address - Country:US
Mailing Address - Phone:412-931-5611
Mailing Address - Fax:413-931-4413
Practice Address - Street 1:1100 CENTER AVE
Practice Address - Street 2:
Practice Address - City:WEST VIEW
Practice Address - State:PA
Practice Address - Zip Code:15229-1636
Practice Address - Country:US
Practice Address - Phone:412-931-5611
Practice Address - Fax:413-931-4413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-01
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS022503L1223G0001X
PADS021863L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty