Healthcare Provider Details

I. General information

NPI: 1861478455
Provider Name (Legal Business Name): ERIC RYAN SMIGA D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 FORT COUCH RD STE 450
PITTSBURGH PA
15241-1031
US

IV. Provider business mailing address

5820 CENTRE AVE STE 200
PITTSBURGH PA
15206-3710
US

V. Phone/Fax

Practice location:
  • Phone: 412-595-7775
  • Fax:
Mailing address:
  • Phone: 412-661-7693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberDS030569L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDS030569L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: