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General NPI Number Information
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NPI Number | 1346796869
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL DENTAL ALLIANCE SPECIALTY, LLC
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Dates
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Enumeration Date | 08/26/2016
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Last Update Date | 08/26/2016
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Provider Practice Location Address
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Address Line | 7131 SPRING MEADOWS DR W SUITE C
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City | HOLLAND
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State | OH
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Zip | 43528-7939
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Country | US
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Telephone | 419-865-7433
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Fax | 419-865-7680
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Provider Business Mailing Address
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Address Line | 11 S MILL ST STE 200
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City | NEW CASTLE
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State | PA
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Zip | 16101-3613
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Country | US
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Telephone | 724-698-2132
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Fax | 724-652-4619
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Authorized Official
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Title or Position | CRED SPECIALIST
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Name | MARIA JONES
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Credential |
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Telephone | 724-698-2132
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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