Healthcare Provider Details

I. General information

NPI: 1689665192
Provider Name (Legal Business Name): MOHSEN AZARBAL DMD, MSD.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 TERRACE STREET SUITE 3189
PITTSBURGH PA
15261-0001
US

IV. Provider business mailing address

C-2070 SALK HALL, UNIVERSITY OF PITTSBURGH
PITTSBURGH PA
15261-0001
US

V. Phone/Fax

Practice location:
  • Phone: 412-648-9100
  • Fax:
Mailing address:
  • Phone: 412-648-8453
  • Fax: 412-648-8850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDS018846L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: