Provider Demographics
NPI:1528118221
Name:FEDORCHAK, RODNEY N (DMD)
Entity type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:N
Last Name:FEDORCHAK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:995 BEAVER GRADE RD
Mailing Address - Street 2:A2
Mailing Address - City:MOON TWP
Mailing Address - State:PA
Mailing Address - Zip Code:15108
Mailing Address - Country:US
Mailing Address - Phone:412-262-3707
Mailing Address - Fax:
Practice Address - Street 1:995 BEAVER GRADE RD
Practice Address - Street 2:A2
Practice Address - City:MOON TWP
Practice Address - State:PA
Practice Address - Zip Code:15108
Practice Address - Country:US
Practice Address - Phone:412-262-3707
Practice Address - Fax:412-262-7207
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS018984L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist