Healthcare Provider Details

I. General information

NPI: 1063950251
Provider Name (Legal Business Name): MRS. ALYSSA MARIE STILES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2017
Last Update Date: 06/23/2021
Certification Date: 06/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 SHADY AVE # G-100
PITTSBURGH PA
15206-4409
US

IV. Provider business mailing address

401 SHADY AVE # G-100
PITTSBURGH PA
15206-4409
US

V. Phone/Fax

Practice location:
  • Phone: 412-407-2668
  • Fax:
Mailing address:
  • Phone: 412-407-2668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH071760
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberPHDH000970
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDHA002013
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMSG013114
License Number StatePA
# 5
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code126800000X
TaxonomyDental Assistant
License NumberDF004742
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: