Provider Demographics
NPI:1194788653
Name:UNIVERSITY DENTAL HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:UNIVERSITY DENTAL HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEAN OF THE UNIVERSITY OF PITTSBURG
Authorized Official - Prefix:
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:COSTELLO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MD
Authorized Official - Phone:412-648-9100
Mailing Address - Street 1:3501 TERRACE STREET
Mailing Address - Street 2:SUITE 3189
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15261
Mailing Address - Country:US
Mailing Address - Phone:412-648-9100
Mailing Address - Fax:412-383-7862
Practice Address - Street 1:3501 TERRACE STREET
Practice Address - Street 2:SUITE 3189
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15261
Practice Address - Country:US
Practice Address - Phone:412-648-9100
Practice Address - Fax:412-383-7862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-07
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223E0200X, 1223G0001X, 1223P0221X, 1223P0300X, 1223P0700X, 1223S0112X, 1223X0400X, 125Q00000X, 207L00000X
PA1223G0001X, 291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No125Q00000XDental ProvidersDentistOral MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017875510003Medicaid
PA0017875510003Medicaid