1720144256 NPI number — UPMC CHILDREN'S HOSPITAL OF PITTSBURGH DENTAL PROGRAM

Table of content: (NPI 1720144256)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720144256 NPI number — UPMC CHILDREN'S HOSPITAL OF PITTSBURGH DENTAL PROGRAM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UPMC CHILDREN'S HOSPITAL OF PITTSBURGH DENTAL PROGRAM
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:
1720144256
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/31/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 382007
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15251-8007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-692-5440
Provider Business Mailing Address Fax Number:
412-692-7946

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3705 5TH AVE
Provider Second Line Business Practice Location Address:
GROUND FLOOR
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-692-5440
Provider Business Practice Location Address Fax Number:
412-692-7946
Provider Enumeration Date:
12/29/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SCOTT
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
E
Authorized Official Title or Position:
MANGER
Authorized Official Telephone Number:
412-692-6805

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X , with the licence number:  DS036645 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000149658 . This is a "UCCI" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1007347990015 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".