Provider Demographics
NPI:1497176184
Name:PITTSBURGH DENTAL SLEEP MEDICINE, INC.
Entity Type:Organization
Organization Name:PITTSBURGH DENTAL SLEEP MEDICINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:III
Authorized Official - Credentials:DMD
Authorized Official - Phone:724-935-6670
Mailing Address - Street 1:11676 PERRY HWY STE 3201
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-7204
Mailing Address - Country:US
Mailing Address - Phone:724-935-6670
Mailing Address - Fax:724-935-6758
Practice Address - Street 1:3824 NORTHERN PIKE STE 100
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-2162
Practice Address - Country:US
Practice Address - Phone:412-823-1400
Practice Address - Fax:412-823-1414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-23
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS020317L1223G0001X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA5972810005Medicare NSC