MEDICARE: BRIGHTON HEIGHTS 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	122300000X	Dentist	DS026626-L	PA

General Provider Information

NPI Number	:	1386185981
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIGHTON HEIGHTS DENTAL

Provider Business Mailing Address
First Line	:	3808 BRIGHTON RD
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15212-1676
Country	:	US
Telephone Number	:	412-766-3100
Fax Number	:	412-766-0262

Provider Business Practice Location Address
First Line	:	3808 BRIGHTON RD
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15212-1676
Country	:	US
Telephone Number	:	412-766-3100
Fax Number	:	412-766-0262

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	TRACY MIHOK
Credential	:
Telephone Number	:	412-461-0453

Provider Enumeration Date	:	03/15/2017
Last Update Date	:	03/15/2017

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Directions to “BRIGHTON HEIGHTS DENTAL ” Practice Location

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