Provider Demographics
NPI:1447874490
Name:PEACE DENTAL ASSOCIATES
Entity type:Organization
Organization Name:PEACE DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:PEACE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:412-874-9229
Mailing Address - Street 1:1509 MOUNT ROYAL BLVD
Mailing Address - Street 2:
Mailing Address - City:GLENSHAW
Mailing Address - State:PA
Mailing Address - Zip Code:15116-2207
Mailing Address - Country:US
Mailing Address - Phone:814-421-8727
Mailing Address - Fax:
Practice Address - Street 1:35 S 2ND AVE
Practice Address - Street 2:
Practice Address - City:CLARION
Practice Address - State:PA
Practice Address - Zip Code:16214-1934
Practice Address - Country:US
Practice Address - Phone:814-226-8690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-05
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty