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NPI Code Detail

MEDICARE: PROFESSIONAL DENTAL ALLIANCE OF FLAT ROCK, PLLC

MEDICARE: PROFESSIONAL DENTAL ALLIANCE OF FLAT ROCK, PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist

General Provider Information

NPI Number : 1508378969
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROFESSIONAL DENTAL ALLIANCE OF FLAT ROCK, PLLC
Provider Business Mailing Address
First Line : 125 ENTERPRISE DR STE 200
Second Line :
City : PITTSBURGH
State : PA
Zip : 15275-1223
Country : US
Telephone Number : 724-698-2500
Fax Number :
Provider Business Practice Location Address
First Line : 26500 W HURON RIVER DR
Second Line :
City : FLAT ROCK
State : MI
Zip : 48134-1135
Country : US
Telephone Number : 734-782-3500
Fax Number :
Authorized Official
Title or Position : CREDENTIALING
Name : ERICA QUINTEROS
Credential :
Telephone Number : 724-901-1964
Provider Enumeration Date : 10/25/2017
Last Update Date : 04/05/2024

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