1033230511 NPI number — RICHARD A. DUKOVICH, D.M.D.

Table of content: (NPI 1033230511)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033230511 NPI number — RICHARD A. DUKOVICH, D.M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RICHARD A. DUKOVICH, D.M.D.
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:
1033230511
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4880 LIBRARY RD STE F
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BETHEL PARK
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15102-2946
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-831-3853
Provider Business Mailing Address Fax Number:
412-831-7425

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4880 LIBRARY RD STE F
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BETHEL PARK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15102-2946
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-831-3853
Provider Business Practice Location Address Fax Number:
412-831-7425
Provider Enumeration Date:
04/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DUKOVICH
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
DENTIST OWNER
Authorized Official Telephone Number:
412-831-3853

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  DS025717L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 122300000X , with the licence number: DS036422L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 172-4132 . This is a "CONCORDIA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1902976889 . This is a "KORCH NPI" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 435-351 . This is a "CONCORDIA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 192-4037 . This is a "CONCORDIA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1821105917 . This is a "DUKOVICH NPI" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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