Healthcare Provider Details

I. General information

NPI: 1700952074
Provider Name (Legal Business Name): WILLIAM M IOVINO DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4055 MONROEVILLE BLVD SUITE 315
MONROEVILLE PA
15146-2522
US

IV. Provider business mailing address

4055 MONROEVILLE BLVD SUITE 315
MONROEVILLE PA
15146-2522
US

V. Phone/Fax

Practice location:
  • Phone: 412-372-0580
  • Fax: 412-373-9243
Mailing address:
  • Phone: 412-372-0580
  • Fax: 412-373-9243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDS020746L
License Number StatePA

VIII. Authorized Official

Name: DR. WILLIAM MICHAEL IOVINO
Title or Position: PRESIDENT
Credential: DMD
Phone: 412-372-0580