Upmc Braddock Dental Center
Organization Active NPI General Practice Dentistry · Braddock, PA
NPI 1457579773 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1457579773
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Practice Dentistry 1223G0001X
- Legal business name
- UPMC BRADDOCK DENTAL CENTER
- Practice address
- 450 Holland Ave
Suite 209
Braddock, PA 15104-1536 - Phone
- (412) 636-5187
- Fax
- (412) 636-5248
- NPI assigned
- Apr 23, 2007
- Organization subpart
- No
Authorized official
- Name
- Mr. Mark S. Sevco
- Title
- President
- Phone
- (412) 636-5100
Corporate family (same tax ID) 2
National Provider Directory
- Tax ID family
- Braddock Medical Center
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry |
1223G0001X | Yes |
Addresses
Primary practice location
450 Holland Ave
Suite 209
Braddock, PA 15104-1536
Mailing address
450 Holland Ave.
Suite 209
Braddock, PA 15104-1536
Phone (412) 636-5187
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 101566-1 | Medicaid | PA | |
| 1411127 | Other | PA | UNITED CONCORDIA |
| 1007360690010 | Medicaid | PA |
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All providers in Braddock, PA · General Practice Dentistry in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.