Provider Demographics
NPI:1366115131
Name:ACTDENTAL,INC
Entity type:Organization
Organization Name:ACTDENTAL,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:THEOFILOS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:724-346-5173
Mailing Address - Street 1:2213 SHENANGO VALLEY FWY
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-2544
Mailing Address - Country:US
Mailing Address - Phone:172-434-6517
Mailing Address - Fax:
Practice Address - Street 1:2213 SHENANGO VALLEY FWY
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-2544
Practice Address - Country:US
Practice Address - Phone:724-346-5173
Practice Address - Fax:724-983-9064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty