=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922469675
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MATTHEW BEAU HESS DMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/09/2016
-----------------------------------------------------
Last Update Date | 03/09/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4156 LIBRARY RD
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15234-1349
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-561-4464
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8001 SADDLEWOOD DR
-----------------------------------------------------
City | BRIDGEVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15017-1180
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-427-1633
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | DS040695
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------