Provider Demographics
NPI:1588686034
Name:GLEASON, PAUL JOSEPH (DMD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JOSEPH
Last Name:GLEASON
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 1:6314 FORBES AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15217-1717
Mailing Address - Country:US
Mailing Address - Phone:412-731-8700
Mailing Address - Fax:412-251-0892
Practice Address - Street 1:6314 FORBES AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15217-1717
Practice Address - Country:US
Practice Address - Phone:412-731-8700
Practice Address - Fax:412-251-0892
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025290-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA39541OtherUNITED CONCORDIA