Provider Demographics
NPI:1215572318
Name:POLISH CROWN DENTAL LLC
Entity type:Organization
Organization Name:POLISH CROWN DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/HYGIENIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:COYLE
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:412-921-7575
Mailing Address - Street 1:974 GREENTREE RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15220-3304
Mailing Address - Country:US
Mailing Address - Phone:412-921-7575
Mailing Address - Fax:412-921-7550
Practice Address - Street 1:974 GREENTREE RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15220-3304
Practice Address - Country:US
Practice Address - Phone:412-921-7575
Practice Address - Fax:412-921-7550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-12
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1801358213OtherNPI