Organization
ALLISON PARK DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASON FEDERER (OWNER)
(727) 463-8284
Entity
Organization
Contact information
Practice address
4290 WILLIAM FLYNN HWY, ALLISON PARK, PA 15101-1443
(412) 487-2800
Mailing address
PO BOX 66, HOUSTON, PA 15342-0066
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
1223P0221X
Pediatric Dentistry
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0008228610001
—
PA
Enumeration date
03/20/2017
Last updated
03/20/2017
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