Provider Demographics
NPI:1932569886
Name:HEALTH AND DENTAL CENTER OF FRANKLIN PARK, LLC
Entity Type:Organization
Organization Name:HEALTH AND DENTAL CENTER OF FRANKLIN PARK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:STARK
Authorized Official - Suffix:II
Authorized Official - Credentials:DDS
Authorized Official - Phone:412-496-7906
Mailing Address - Street 1:2415 NICHOLSON RD
Mailing Address - Street 2:
Mailing Address - City:SEWICKLEY
Mailing Address - State:PA
Mailing Address - Zip Code:15143-8508
Mailing Address - Country:US
Mailing Address - Phone:412-364-5252
Mailing Address - Fax:
Practice Address - Street 1:2415 NICHOLSON RD
Practice Address - Street 2:
Practice Address - City:SEWICKLEY
Practice Address - State:PA
Practice Address - Zip Code:15143-8508
Practice Address - Country:US
Practice Address - Phone:412-364-5252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTH AND DENTAL CENTER OF FRANKLIN PARK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025208L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty