Provider Demographics
NPI:1215906268
Name:ATCHESON, IRA DAVID (DMD)
Entity type:Individual
Prefix:DR
First Name:IRA
Middle Name:DAVID
Last Name:ATCHESON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:I
Other - Middle Name:DAVID
Other - Last Name:ATCHESON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:255 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009-2350
Mailing Address - Country:US
Mailing Address - Phone:724-728-1700
Mailing Address - Fax:724-728-1413
Practice Address - Street 1:255 3RD ST
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-2350
Practice Address - Country:US
Practice Address - Phone:724-728-1700
Practice Address - Fax:724-728-1413
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-017928-L1223P0106X
OH30-0192241223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0882242Medicaid
OH0804268Medicaid
PA161284Medicare PIN
OH0692721Medicare PIN
PAT29802Medicare UPIN