Healthcare Provider Details

I. General information

NPI: 1700936085
Provider Name (Legal Business Name): PITTSBURGH DENTAL SLEEP MEDICINE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11676 PERRY HWY SUITE 3201
WEXFORD PA
15090
US

IV. Provider business mailing address

11676 PERRY HWY SUITE 3201
WEXFORD PA
15090-7201
US

V. Phone/Fax

Practice location:
  • Phone: 724-935-6670
  • Fax: 724-935-6758
Mailing address:
  • Phone: 724-935-6670
  • Fax: 724-935-6758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberDS020317L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License NumberDS020317L
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS020317L
License Number StatePA

VIII. Authorized Official

Name: DR. ROBERT RICHARD ROGERS III
Title or Position: PRESIDENT
Credential: DMD
Phone: 724-935-6670