Provider Demographics
NPI:1669847521
Name:DENTISTRY FOR KIDS
Entity type:Organization
Organization Name:DENTISTRY FOR KIDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:412-367-2250
Mailing Address - Street 1:2790 MOSSIDE BLVD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-2743
Mailing Address - Country:US
Mailing Address - Phone:412-367-2250
Mailing Address - Fax:412-367-0930
Practice Address - Street 1:244 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-2706
Practice Address - Country:US
Practice Address - Phone:724-888-2684
Practice Address - Fax:724-709-8061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-03
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026194L1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty