Healthcare Provider Details

I. General information

NPI: 1568051027
Provider Name (Legal Business Name): FACIAL SURGERY CENTER OF MONROEVILLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2021
Last Update Date: 01/12/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2790 MOSSIDE BLVD
MONROEVILLE PA
15146-2743
US

IV. Provider business mailing address

459 LAKEWOOD RD
GREENSBURG PA
15601-9772
US

V. Phone/Fax

Practice location:
  • Phone: 412-790-5535
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number
License Number State

VIII. Authorized Official

Name: AMY PFEIFER
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 724-836-1060