Provider Demographics
NPI:1619172087
Name:CRANBERRY DENTAL INC
Entity type:Organization
Organization Name:CRANBERRY DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:KLAICH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:724-776-2280
Mailing Address - Street 1:10011 PENDLETON WAY
Mailing Address - Street 2:
Mailing Address - City:CRANBERRY TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-6900
Mailing Address - Country:US
Mailing Address - Phone:724-776-2280
Mailing Address - Fax:724-776-0242
Practice Address - Street 1:10011 PENDLETON WAY
Practice Address - Street 2:
Practice Address - City:CRANBERRY TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:16066-6900
Practice Address - Country:US
Practice Address - Phone:724-776-2280
Practice Address - Fax:724-776-0242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0355651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty