Provider Demographics
NPI:1699739300
Name:PETCASH, ROBERT A (DMD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:PETCASH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2879 W HARDIES RD
Mailing Address - Street 2:
Mailing Address - City:GIBSONIA
Mailing Address - State:PA
Mailing Address - Zip Code:15044-8290
Mailing Address - Country:US
Mailing Address - Phone:724-444-7770
Mailing Address - Fax:724-444-7676
Practice Address - Street 1:2879 W HARDIES RD
Practice Address - Street 2:
Practice Address - City:GIBSONIA
Practice Address - State:PA
Practice Address - Zip Code:15044-8290
Practice Address - Country:US
Practice Address - Phone:724-444-7770
Practice Address - Fax:724-444-7676
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-027733-L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA027733OtherCIGNA
PA2118131OtherAETNA US HEALTHCARE
PA93946OtherHEALTH AMERICA
PA16059170003Medicaid
PA2118131OtherAETNA US HEALTHCARE
PA93946OtherHEALTH AMERICA