# EDP OF PENNSYLVANIA PC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** EDP OF PENNSYLVANIA PC
- **Other names:** The Dentistry of West Mifflin
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1285196246
- **Legal business name:** EDP OF PENNSYLVANIA PC
- **Authorized official:** ROSEANNE BRUNENKANT (DIRECTOR OF INTEGRATIONS)
- **Authorized official phone:** (312) 937-3619

## Contact information

- **Practice address:** 4945 HOMEVILLE RD, WEST MIFFLIN, PA 15122-2969
- **Practice address phone:** (312) 800-1270
- **Mailing address:** 141 W JACKSON BLVD STE 210, CHICAGO, IL 60604-3048
- **Mailing address phone:** (312) 937-3619

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 04/01/2019
- **Last updated:** 09/16/2019