Healthcare Provider Details

I. General information

NPI: 1811904980
Provider Name (Legal Business Name): PITTSBURGH ORAL SURGERY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 08/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5820 CENTRE AVE SUITE 200
PITTSBURGH PA
15206-3710
US

IV. Provider business mailing address

5820 CENTRE AVE SUITE 200
PITTSBURGH PA
15206-3710
US

V. Phone/Fax

Practice location:
  • Phone: 412-661-7690
  • Fax: 412-661-7695
Mailing address:
  • Phone: 412-661-7690
  • Fax: 412-661-7695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State

VIII. Authorized Official

Name: DR. MARTIN E EICHNER
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 412-661-7690