Three Rivers Dental Group/Jennerstown LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

THREE RIVERS DENTAL GROUP/JENNERSTOWN LLC

Practice address

1609 Pitt Street
Jennerstown, PA 15527

Phone

(814) 629-6621

Fax

(814) 629-6622

NPI assigned

Feb 26, 2010

Last updated

Mar 8, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ana Bianca Rudolph, DMD

Title

Managing Member

Phone

(724) 961-4363

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1267142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678233600000",
    "number": "1639491046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1609 PITT STREET",
            "city": "JENNERSTOWN",
            "state": "PA",
            "postal_code": "15527",
            "telephone_number": "814-629-6621",
            "fax_number": "814-629-6622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1609 PITT STREET",
            "city": "JENNERSTOWN",
            "state": "PA",
            "postal_code": "15527",
            "telephone_number": "814-629-6621",
            "fax_number": "814-629-6622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THREE RIVERS DENTAL GROUP/JENNERSTOWN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-26",
        "last_updated": "2023-03-08",
        "certification_date": "2023-03-08",
        "status": "A",
        "authorized_official_last_name": "RUDOLPH",
        "authorized_official_first_name": "ANA BIANCA",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "724-961-4363",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Theresa Krouse, BSN, RN, FNP-S
• Jacqueline M. Martella, RPH
• Alexander G Paterson, MD
• Christina Sutton Pienkowski, PHARMD
• Vicki Jean Price, RPH

• General Practice Dentistry in Jennerstown, PA
• Providers in Jennerstown, PA by specialty
• General Practice Dentistry in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.