Provider Demographics
NPI:1447021639
Name:PGH SMILE BOUTIQUE PLLC
Entity type:Organization
Organization Name:PGH SMILE BOUTIQUE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:P
Authorized Official - Last Name:SHIEH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:724-799-8100
Mailing Address - Street 1:904 WARRENDALE VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:WARRENDALE
Mailing Address - State:PA
Mailing Address - Zip Code:15086-7539
Mailing Address - Country:US
Mailing Address - Phone:724-799-8100
Mailing Address - Fax:724-799-8102
Practice Address - Street 1:904 WARRENDALE VILLAGE DR
Practice Address - Street 2:
Practice Address - City:WARRENDALE
Practice Address - State:PA
Practice Address - Zip Code:15086-7539
Practice Address - Country:US
Practice Address - Phone:724-799-8100
Practice Address - Fax:724-799-8102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental