MEDICARE: PROSTHETIC DENTISTRY OF MOUNT LEBANON, PC

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	DSO27906L	PA

General Provider Information

NPI Number	:	1952684334
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROSTHETIC DENTISTRY OF MOUNT LEBANON, PC

Provider Business Mailing Address
First Line	:	603 WASHINGTON RD
Second Line	:	SUITE 200
City	:	PITTSBURGH
State	:	PA
Zip	:	15228-1909
Country	:	US
Telephone Number	:	412-343-9100
Fax Number	:	412-343-9101

Provider Business Practice Location Address
First Line	:	603 WASHINGTON RD
Second Line	:	SUITE 200
City	:	PITTSBURGH
State	:	PA
Zip	:	15228-1909
Country	:	US
Telephone Number	:	412-343-9100
Fax Number	:	412-343-9101

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PHYLLIS CALLAHAN LEE
Credential	:	DMD
Telephone Number	:	412-343-9100

Provider Enumeration Date	:	09/22/2011
Last Update Date	:	09/22/2011

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