Provider Demographics
NPI:1922829332
Name:DENTAL IMPLANT SPECIALISTS OF PENNSYLVANIA I, PC
Entity type:Organization
Organization Name:DENTAL IMPLANT SPECIALISTS OF PENNSYLVANIA I, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:TUNDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-788-9333
Mailing Address - Street 1:3500 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-3906
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4955 STEUBENVILLE PIKE STE 361
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15205-9604
Practice Address - Country:US
Practice Address - Phone:412-788-9333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty