Provider Demographics
NPI:1417126228
Name:MYCHAK, ADAM WILLIAM (DMD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:WILLIAM
Last Name:MYCHAK
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 1:1408 EAST CARSON ST
Mailing Address - Street 2:SOUTH SIDE DENTAL PAVILION
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15203
Mailing Address - Country:US
Mailing Address - Phone:412-431-6631
Mailing Address - Fax:412-431-6297
Practice Address - Street 1:1408 EAST CARSON ST
Practice Address - Street 2:SOUTH SIDE DENTAL PAVILION
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15203
Practice Address - Country:US
Practice Address - Phone:412-431-6631
Practice Address - Fax:412-431-6297
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS037298L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice