Healthcare Provider Details

I. General information

NPI: 1487589719
Provider Name (Legal Business Name): BRENO MONTEIRO TAVARES DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7219 MCKNIGHT RD STE D
PITTSBURGH PA
15237-3524
US

IV. Provider business mailing address

617 BROADMORE LN
WEXFORD PA
15090-1505
US

V. Phone/Fax

Practice location:
  • Phone: 412-595-1212
  • Fax:
Mailing address:
  • Phone: 412-595-1212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS045883
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: