MEDICARE: KAYLEIGH MORT 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	DS042322	PA

General Provider Information

NPI Number	:	1669034104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLEIGH MORT DMD

Provider Business Mailing Address
First Line	:	8003 HINSDALE LN
Second Line	:
City	:	MC DONALD
State	:	PA
Zip	:	15057-3576
Country	:	US
Telephone Number	:	412-527-0036
Fax Number	:

Provider Business Practice Location Address
First Line	:	1302 FREEDOM RD
Second Line	:
City	:	CRANBERRY TWP
State	:	PA
Zip	:	16066-5016
Country	:	US
Telephone Number	:	724-772-2788
Fax Number	:

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

Provider Enumeration Date	:	07/05/2019
Last Update Date	:	07/05/2019

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