Provider Demographics
NPI:1538291075
Name:DASH, MARVIN A (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:A
Last Name:DASH
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 1:355 5TH AVE
Mailing Address - Street 2:PARK BUILDING SUITE 1300
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15222-2409
Mailing Address - Country:US
Mailing Address - Phone:412-765-1030
Mailing Address - Fax:412-765-2363
Practice Address - Street 1:355 5TH AVE
Practice Address - Street 2:PARK BUILDING SUITE 1300
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15222-2409
Practice Address - Country:US
Practice Address - Phone:412-765-1030
Practice Address - Fax:412-765-2363
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-11
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS019088L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007069890001Medicaid
PA153846Medicare ID - Type Unspecified
PAT29709Medicare UPIN