Provider Demographics
NPI:1144832551
Name:AST, BRIAN (DMD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:AST
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 1:12C S 26TH ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15203-2367
Mailing Address - Country:US
Mailing Address - Phone:412-773-1473
Mailing Address - Fax:
Practice Address - Street 1:7372 MCKNIGHT RD STE B
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-3558
Practice Address - Country:US
Practice Address - Phone:412-364-6440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0427271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice