Provider Demographics
NPI:1750558995
Name:AESTHETIC DENTAL CENTER OF FINLEYVILLE
Entity type:Organization
Organization Name:AESTHETIC DENTAL CENTER OF FINLEYVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:RABATIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-348-4777
Mailing Address - Street 1:6108 BROWNSVILLE ROAD EXT
Mailing Address - Street 2:SUITE 206
Mailing Address - City:FINLEYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15332-4132
Mailing Address - Country:US
Mailing Address - Phone:724-348-4777
Mailing Address - Fax:724-348-7524
Practice Address - Street 1:6108 BROWNSVILLE ROAD EXT
Practice Address - Street 2:SUITE 206
Practice Address - City:FINLEYVILLE
Practice Address - State:PA
Practice Address - Zip Code:15332-4132
Practice Address - Country:US
Practice Address - Phone:724-348-4777
Practice Address - Fax:724-348-7524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025257L1223G0001X
PADS026573L1223G0001X
PADS026782L1223P0300X
PADS026411L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty