MEDICARE: SOUTH VUE DENTISTRY

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	261QD0000X	Dental Clinic/Center	DS039568	PA

General Provider Information

NPI Number	:	1760971345
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH VUE DENTISTRY

Provider Business Mailing Address
First Line	:	180 FORT COUCH RD STE 415
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15241-1050
Country	:	US
Telephone Number	:	412-835-2288
Fax Number	:	412-835-8054

Provider Business Practice Location Address
First Line	:	180 FORT COUCH RD STE 415
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15241-1050
Country	:	US
Telephone Number	:	412-835-2288
Fax Number	:	412-835-8054

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. WESLEY HOWARD
Credential	:	DDS
Telephone Number	:	412-835-2288

Provider Enumeration Date	:	05/09/2018
Last Update Date	:	05/09/2018

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Directions to “SOUTH VUE DENTISTRY ” Practice Location

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