Healthcare Provider Details

I. General information

NPI: 1518618875
Provider Name (Legal Business Name): WOW IN SMILE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2022
Last Update Date: 01/18/2022
Certification Date: 01/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 GRANDVIEW AVE STE 200
PITTSBURGH PA
15211-4200
US

IV. Provider business mailing address

1301 GRANDVIEW AVE STE 200
PITTSBURGH PA
15211-4200
US

V. Phone/Fax

Practice location:
  • Phone: 412-298-2734
  • Fax:
Mailing address:
  • Phone: 412-298-2734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. SUSAN MCMAHON
Title or Position: CEO
Credential: DMD
Phone: 412-370-9875