Provider Demographics
NPI:1083847990
Name:WINNING SMILE DENTISTRY
Entity Type:Organization
Organization Name:WINNING SMILE DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AKUVI
Authorized Official - Middle Name:MAMU
Authorized Official - Last Name:KLOUTSE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:412-726-3797
Mailing Address - Street 1:4721 MCKNIGHT RD
Mailing Address - Street 2:NOTHLAND, SUITE 214
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-3415
Mailing Address - Country:US
Mailing Address - Phone:412-366-8550
Mailing Address - Fax:412-366-2034
Practice Address - Street 1:702 SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:MOUNT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15211-2253
Practice Address - Country:US
Practice Address - Phone:412-726-3797
Practice Address - Fax:412-481-0192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-25
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADSO364321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1018235160001Medicaid