Provider Demographics
NPI:1154892297
Name:WESTERN PENNSYLVANIA DENTAL GROUP
Entity type:Organization
Organization Name:WESTERN PENNSYLVANIA DENTAL GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-2100
Mailing Address - Street 1:4774 OLD WILLIAM PENN HWY STE 200
Mailing Address - Street 2:
Mailing Address - City:MURRYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15668-2011
Mailing Address - Country:US
Mailing Address - Phone:724-325-3770
Mailing Address - Fax:724-325-1274
Practice Address - Street 1:4774 OLD WILLIAM PENN HWY STE 200
Practice Address - Street 2:
Practice Address - City:MURRYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15668-2011
Practice Address - Country:US
Practice Address - Phone:724-325-3770
Practice Address - Fax:724-325-1274
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESTERN PENNSYLVANIA DENTAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-12-16
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1396878393OtherDENTAL