MEDICARE: DR. PAUL JOSEPH GLEASON 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	1223G0001X	General Practice Dentistry	DS025290-L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	39541	OTHER	PA	UNITED CONCORDIA

General Provider Information

NPI Number	:	1588686034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL JOSEPH GLEASON D.M.D.

Provider Business Mailing Address
First Line	:	6314 FORBES AVE
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15217-1717
Country	:	US
Telephone Number	:	412-731-8700
Fax Number	:	412-251-0892

Provider Business Practice Location Address
First Line	:	6314 FORBES AVE
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15217-1717
Country	:	US
Telephone Number	:	412-731-8700
Fax Number	:	412-251-0892

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

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	08/12/2013

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