MEDICARE: ADAM WILLIAM MYCHAK 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	1223G0001X	General Practice Dentistry	DS037298L	PA

General Provider Information

NPI Number	:	1417126228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADAM WILLIAM MYCHAK DMD

Provider Business Mailing Address
First Line	:	1408 EAST CARSON ST
Second Line	:	SOUTH SIDE DENTAL PAVILION
City	:	PITTSBURGH
State	:	PA
Zip	:	15203
Country	:	US
Telephone Number	:	412-431-6631
Fax Number	:	412-431-6297

Provider Business Practice Location Address
First Line	:	1408 EAST CARSON ST
Second Line	:	SOUTH SIDE DENTAL PAVILION
City	:	PITTSBURGH
State	:	PA
Zip	:	15203
Country	:	US
Telephone Number	:	412-431-6631
Fax Number	:	412-431-6297

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

Provider Enumeration Date	:	02/26/2008
Last Update Date	:	02/26/2008

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