Provider Demographics
NPI:1104298728
Name:COMPLETE DENTAL CARE OF WHITAKER
Entity type:Organization
Organization Name:COMPLETE DENTAL CARE OF WHITAKER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:DOYLE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:412-462-7710
Mailing Address - Street 1:107 WHITAKER ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:PA
Mailing Address - Zip Code:15120-2411
Mailing Address - Country:US
Mailing Address - Phone:412-462-7710
Mailing Address - Fax:412-462-7710
Practice Address - Street 1:107 WHITAKER ST
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:PA
Practice Address - Zip Code:15120-2411
Practice Address - Country:US
Practice Address - Phone:412-462-7710
Practice Address - Fax:412-462-7710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-22
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS037954122300000X
PADS035693122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102026760Medicaid
PA10303064Medicaid