Healthcare Provider Details

I. General information

NPI: 1003386004
Provider Name (Legal Business Name): PITTSBURGH DENTAL SLEEP MEDICINE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2018
Last Update Date: 12/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3055 WASHINGTON RD STE 302
MC MURRAY PA
15317-3279
US

IV. Provider business mailing address

11676 PERRY HWY STE 3201
WEXFORD PA
15090-7204
US

V. Phone/Fax

Practice location:
  • Phone: 724-935-6670
  • Fax: 724-942-5632
Mailing address:
  • Phone: 724-935-6670
  • Fax: 724-935-6758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MARY BETH ROGERS
Title or Position: VICE PRESIDENT
Credential:
Phone: 724-935-6670