# EDP OF PENNSYLVANIA PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366958407
- **Authorized official:** MELISSA GARIBAY (CREDENTIALING MNGR.)
- **Authorized official phone:** (312) 736-8963

## Contact information

- **Practice address:** 1390 EISENHOWER BLVD, JOHNSTOWN, PA 15904-3216
- **Practice address phone:** (814) 535-5244
- **Mailing address:** 141 W JACKSON BLVD STE 210, CHICAGO, IL 60604-3048
- **Mailing address phone:** (312) 800-1270

## Taxonomy

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

## Other

- **Enumeration date:** 12/27/2017
- **Last updated:** 09/20/2021