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Organization
UPMC BRADDOCK DENTAL CENTER
Active
Organization
UPMC BRADDOCK DENTAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK S. SEVCO (PRESIDENT)
(412) 636-5100
Entity
Organization
Contact information
Practice address
450 HOLLAND AVE, SUITE 209, BRADDOCK, PA 15104-1536
(412) 636-5187
(412) 636-5248
Mailing address
450 HOLLAND AVE., SUITE 209, BRADDOCK, PA 15104-1536
(412) 636-5187
(412) 636-5248
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007360690010
—
PA
05
—
101566-1
—
PA
01
—
1411127
UNITED CONCORDIA
PA
Enumeration date
04/23/2007
Last updated
08/22/2020
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