MEDICARE: RICHARD J MIGGANTZ D.M.D.

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	1223P0300X	Periodontics	DSO21299L	PA

General Provider Information

NPI Number	:	1326148461
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD J MIGGANTZ D.M.D.

Provider Business Mailing Address
First Line	:	1215 LONG RUN RD
Second Line	:
City	:	MCKEESPORT
State	:	PA
Zip	:	15131-2034
Country	:	US
Telephone Number	:	412-664-4717
Fax Number	:	412-664-1728

Provider Business Practice Location Address
First Line	:	1215 LONG RUN RD
Second Line	:
City	:	MCKEESPORT
State	:	PA
Zip	:	15131-2034
Country	:	US
Telephone Number	:	412-664-4717
Fax Number	:	412-664-1728

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

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	07/08/2007

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