Provider Demographics
NPI:1992700744
Name:DENTISTRY FOR CHILDREN AND TEENS INC.
Entity type:Organization
Organization Name:DENTISTRY FOR CHILDREN AND TEENS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:724-774-1920
Mailing Address - Street 1:PO BOX 537
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009-0537
Mailing Address - Country:US
Mailing Address - Phone:724-774-1920
Mailing Address - Fax:724-774-3332
Practice Address - Street 1:265 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:724-774-1920
Practice Address - Fax:724-774-3332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011869630001Medicaid