Provider Demographics
NPI:1326574286
Name:ADVANCED DENTISTRY OF BUTLER LLC
Entity type:Organization
Organization Name:ADVANCED DENTISTRY OF BUTLER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:FORNALCZYK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-282-4436
Mailing Address - Street 1:10497 ALLANTE CT
Mailing Address - Street 2:
Mailing Address - City:GIBSONIA
Mailing Address - State:PA
Mailing Address - Zip Code:15044-7462
Mailing Address - Country:US
Mailing Address - Phone:724-282-4436
Mailing Address - Fax:724-282-2559
Practice Address - Street 1:101 DECATUR DR
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16002-3891
Practice Address - Country:US
Practice Address - Phone:724-444-0608
Practice Address - Fax:724-282-2559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS021397L261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental