# ALLISON PARK DENTAL

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

## Provider details

- **NPI number:** 1881135184
- **Authorized official:** JASON FEDERER (OWNER)
- **Authorized official phone:** (727) 463-8284

## Contact information

- **Practice address:** 4290 WILLIAM FLYNN HWY, ALLISON PARK, PA 15101-1443
- **Practice address phone:** (412) 487-2800
- **Mailing address:** PO BOX 66, HOUSTON, PA 15342-0066

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |
| 1223P0221X | Pediatric Dentistry | — | NULL | — |
| 1223P0221X | Pediatric Dentistry | — | — | — |

## Other

- **Enumeration date:** 03/20/2017
- **Last updated:** 03/20/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0008228610001 | — | PA |