Provider Demographics
NPI:1588701981
Name:DENTISTRY FOR KIDS, INC
Entity type:Organization
Organization Name:DENTISTRY FOR KIDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:W
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:412-367-2250
Mailing Address - Street 1:8160 PERRY HWY
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-5214
Mailing Address - Country:US
Mailing Address - Phone:412-367-2250
Mailing Address - Fax:412-367-4060
Practice Address - Street 1:3472 ROUTE 130
Practice Address - Street 2:
Practice Address - City:HARRISON CITY
Practice Address - State:PA
Practice Address - Zip Code:15636
Practice Address - Country:US
Practice Address - Phone:412-367-2250
Practice Address - Fax:412-367-4060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA168020OtherUNITED CONCORDIA NUMBER