Healthcare Provider Details

I. General information

NPI: 1265417935
Provider Name (Legal Business Name): MICHAEL ALLEN CUDDY DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 06/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 TERRACE ST. SUITE 3189
PITTSBURGH PA
15261-0001
US

IV. Provider business mailing address

3501 TERRACE ST. G-89 SALK HALL
PITTSBURGH PA
15261
US

V. Phone/Fax

Practice location:
  • Phone: 412-648-9100
  • Fax:
Mailing address:
  • Phone: 412-648-8609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS 029713 L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License NumberDA-029713-A
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: