Provider Demographics
NPI:1164186938
Name:PEARL DENTISTRY OF SOUTH HILLS PLLC
Entity Type:Organization
Organization Name:PEARL DENTISTRY OF SOUTH HILLS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DMD
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:724-612-2729
Mailing Address - Street 1:901 CASTLE SHANNON BLVD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15234-1603
Mailing Address - Country:US
Mailing Address - Phone:412-561-6660
Mailing Address - Fax:412-766-7532
Practice Address - Street 1:901 CASTLE SHANNON BLVD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15234-1603
Practice Address - Country:US
Practice Address - Phone:412-561-6660
Practice Address - Fax:412-766-7532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1164872214Medicaid