MEDICARE: WINNING SMILE DENTISTRY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DSO36432	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083847990
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WINNING SMILE DENTISTRY

Provider Business Mailing Address
First Line	:	4721 MCKNIGHT RD
Second Line	:	NOTHLAND, SUITE 214
City	:	PITTSBURGH
State	:	PA
Zip	:	15237-3415
Country	:	US
Telephone Number	:	412-366-8550
Fax Number	:	412-366-2034

Provider Business Practice Location Address
First Line	:	702 SOUTHERN AVE
Second Line	:
City	:	MOUNT WASHINGTON
State	:	PA
Zip	:	15211-2253
Country	:	US
Telephone Number	:	412-726-3797
Fax Number	:	412-481-0192

Authorized Official
Title or Position	:	OWNER
Name	:	DR. AKUVI MAMU KLOUTSE
Credential	:	DMD
Telephone Number	:	412-726-3797

Provider Enumeration Date	:	08/25/2009
Last Update Date	:	08/25/2009

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Directions to “WINNING SMILE DENTISTRY ” Practice Location

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