Provider Demographics
NPI:1689710287
Name:SUPOWITZ, MARTIN L (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:L
Last Name:SUPOWITZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5433 WALNUT ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15232-3214
Mailing Address - Country:US
Mailing Address - Phone:412-687-3232
Mailing Address - Fax:412-535-0303
Practice Address - Street 1:5433 WALNUT ST
Practice Address - Street 2:SUITE 200
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15232-3214
Practice Address - Country:US
Practice Address - Phone:412-687-3232
Practice Address - Fax:412-535-0303
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-022556-L1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics