1598069486 NPI number — ALLEGHENY DENTAL 1

Table of content: (NPI 1598069486)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598069486 NPI number — ALLEGHENY DENTAL 1

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLEGHENY DENTAL 1
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598069486
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2734 E ALLEGHENY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19134-5917
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-427-2786
Provider Business Mailing Address Fax Number:
215-427-2788

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2734 E ALLEGHENY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19134-5917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-427-2786
Provider Business Practice Location Address Fax Number:
215-427-2788
Provider Enumeration Date:
01/06/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ALOIAN
Authorized Official First Name:
YEKATERINA
Authorized Official Middle Name:
Authorized Official Title or Position:
CLINICAL DIRECTOR
Authorized Official Telephone Number:
215-427-2786

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)