MEDICARE: DR. LEROY EDWARD PRYOR 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	DS024744L	PA

General Provider Information

NPI Number	:	1841275351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEROY EDWARD PRYOR D. M. D.

Provider Business Mailing Address
First Line	:	1502 MOUNT ROYAL BLVD
Second Line	:
City	:	GLENSHAW
State	:	PA
Zip	:	15116-2246
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1724 MOUNT ROYAL BLVD
Second Line	:
City	:	GLENSHAW
State	:	PA
Zip	:	15116-2115
Country	:	US
Telephone Number	:	412-213-1999
Fax Number	:	412-213-6985

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

Provider Enumeration Date	:	12/08/2005
Last Update Date	:	01/09/2013

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