Healthcare Provider Details

I. General information

NPI: 1245889740
Provider Name (Legal Business Name): ORAL & FACIAL SURGERY OF PITTSBURGH, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2019
Last Update Date: 02/22/2023
Certification Date: 02/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 SWINDERMAN RD STE 260
WEXFORD PA
15090-5621
US

IV. Provider business mailing address

180 SWINDERMAN RD STE 260
WEXFORD PA
15090-5621
US

V. Phone/Fax

Practice location:
  • Phone: 412-532-9720
  • Fax: 412-532-9721
Mailing address:
  • Phone: 412-532-9720
  • Fax: 412-532-9721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: KELLY BAUER
Title or Position: OFFICE MANAGER
Credential:
Phone: 412-532-9720