MEDICARE: MT OLIVER DENTAL

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		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	:	1285172080
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MT OLIVER DENTAL

Provider Business Mailing Address
First Line	:	145 BROWNSVILLE RD
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15210-2113
Country	:	US
Telephone Number	:	412-431-0232
Fax Number	:	412-431-5954

Provider Business Practice Location Address
First Line	:	145 BROWNSVILLE RD
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15210-2113
Country	:	US
Telephone Number	:	412-431-0232
Fax Number	:	412-431-5954

Authorized Official
Title or Position	:	DENTIST / OWNER
Name	:	STEPHEN G. DUNN
Credential	:	DMD
Telephone Number	:	412-461-0453

Provider Enumeration Date	:	02/01/2017
Last Update Date	:	02/01/2017

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Directions to “MT OLIVER DENTAL ” Practice Location

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