Provider Demographics
NPI:1508471913
Name:MARTIN L. SUPOWITZ, DMD, MSD, LLC
Entity Type:Organization
Organization Name:MARTIN L. SUPOWITZ, DMD, MSD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:SUPOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MSD
Authorized Official - Phone:412-687-3232
Mailing Address - Street 1:5433 WALNUT ST STE 200
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15232-3215
Mailing Address - Country:US
Mailing Address - Phone:412-687-3232
Mailing Address - Fax:412-535-0303
Practice Address - Street 1:5433 WALNUT ST STE 200
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15232-3215
Practice Address - Country:US
Practice Address - Phone:412-687-3232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty