MEDICARE: PEARL DENTISTRY OF SOUTH HILLS PLLC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164186938
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEARL DENTISTRY OF SOUTH HILLS PLLC

Provider Business Mailing Address
First Line	:	901 CASTLE SHANNON BLVD
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15234-1603
Country	:	US
Telephone Number	:	412-561-6660
Fax Number	:	412-766-7532

Provider Business Practice Location Address
First Line	:	901 CASTLE SHANNON BLVD
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15234-1603
Country	:	US
Telephone Number	:	412-561-6660
Fax Number	:	412-766-7532

Authorized Official
Title or Position	:	OWNER/DMD
Name	:	DR. MATTHEW LEE WEISS
Credential	:	DMD
Telephone Number	:	724-612-2729

Provider Enumeration Date	:	10/27/2021
Last Update Date	:	10/27/2021

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