Provider Demographics
NPI:1033195938
Name:KAHN, MICHAEL ROGER (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ROGER
Last Name:KAHN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 HARTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15208-2701
Mailing Address - Country:US
Mailing Address - Phone:412-244-0533
Mailing Address - Fax:
Practice Address - Street 1:5850 CENTRE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-3780
Practice Address - Country:US
Practice Address - Phone:412-661-7690
Practice Address - Fax:412-661-7695
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS016446L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA124300OtherHIGHMARK BC BS
PA0535460Medicaid
T29616Medicare UPIN
PA148014FQPMedicare ID - Type Unspecified