MEDICARE: DESISLAVA DINOVA DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DS037499	PA

General Provider Information

NPI Number	:	1023264207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DESISLAVA DINOVA DMD

Provider Business Mailing Address
First Line	:	221 DEER MEADOW DR
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15241-2253
Country	:	US
Telephone Number	:	412-708-7621
Fax Number	:

Provider Business Practice Location Address
First Line	:	221 DEER MEADOW DRIVE
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15241-2253
Country	:	US
Telephone Number	:	412-708-7621
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2008
Last Update Date	:	04/07/2016

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