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General NPI Number Information
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NPI Number | 1922572072
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL DENTAL ALLIANCE OF CENTERVILLE, LLC
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Dates
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Enumeration Date | 01/11/2019
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Last Update Date | 07/02/2025
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Provider Practice Location Address
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Address Line | 9420 DAYTON LEBANON PIKE
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City | CENTERVILLE
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State | OH
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Zip | 45458-3860
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Country | US
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Telephone | 877-959-5405
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Fax |
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Provider Business Mailing Address
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Address Line | 125 ENTERPRISE DR STE 200
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City | PITTSBURGH
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State | PA
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Zip | 15275-1223
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Country | US
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Telephone | 724-698-2500
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Fax | 844-399-0385
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Authorized Official
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Title or Position | LEAD CREDENTIALING SPECIALIST
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Name | AMANDA KURTZ
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Credential |
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Telephone | 724-698-2481
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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