Organization
PREMIERE ANESTHESIA FOR DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. VALERIE GRANT (OFFICE MANAGER)
(724) 759-7948
Entity
Organization
Contact information
Practice address
106 VILLAGE PL, WEXFORD, PA 15090-5611
(724) 759-7948
(724) 759-7952
Mailing address
10154 WOODBURY DR, WEXFORD, PA 15090-9580
(724) 759-7948
(724) 759-7952
Taxonomy
Speciality
Code
Description
License number
State
1223D0004X
Dental Anesthesiology
DA031643
PA
1223D0004X
Dental Anesthesiology
DP000682
PA
1223D0004X
Dental Anesthesiology
DS029696L
PA
1223D0004X
Dental Anesthesiology
DS031543L
PA
1223D0004X
Dental Anesthesiology
DS035406
PA
1223D0004X
Dental Anesthesiology
Primary
DS036141
PA
Other
Enumeration date
06/05/2014
Last updated
06/05/2014
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