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General NPI Number Information
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NPI Number | 1487155271
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Entity Type | Organization
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Legal Business Name | NORTHSIDE DENTAL
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Dates
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Enumeration Date | 02/27/2018
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Last Update Date | 02/27/2018
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Provider Practice Location Address
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Address Line | 814 CEDAR AVENUE
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City | PITTSBURGH
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State | PA
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Zip | 15212
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Country | US
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Telephone | 412-366-7788
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Fax |
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Provider Business Mailing Address
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Address Line | 814 CEDAR AVE
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City | PITTSBURGH
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State | PA
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Zip | 15212-4812
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Country | US
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Telephone | 412-366-7788
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Fax | 412-322-1087
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Authorized Official
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Title or Position | OWNER
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Name | DR. ADAM MYCHAK
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Credential | DMD
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Telephone | 412-366-7788
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS037298
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License Number State |
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