Healthcare Provider Details

I. General information

NPI: 1104754613
Provider Name (Legal Business Name): STEPHEN M DEFUSCO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5154 LIBERTY AVE
PITTSBURGH PA
15224-2256
US

IV. Provider business mailing address

5154 LIBERTY AVE
PITTSBURGH PA
15224-2256
US

V. Phone/Fax

Practice location:
  • Phone: 412-688-8446
  • Fax: 412-688-8447
Mailing address:
  • Phone: 412-688-8446
  • Fax: 412-688-8447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: MELISSA BARKOVICH
Title or Position: OFFICE MANAGER
Credential:
Phone: 412-320-3111