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Organization
PROFESSIONAL DENTAL ALLIANCE OF CENTERVILLE, LLC
Active
Organization
PROFESSIONAL DENTAL ALLIANCE OF CENTERVILLE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAUREN HOWARD (CREDENTIALING SPECIALIST)
(757) 576-5479
Entity
Organization
Contact information
Practice address
9420 DAYTON LEBANON PIKE, CENTERVILLE, OH 45458-3860
(937) 433-8900
Mailing address
11 S MILL ST STE 200, NEW CASTLE, PA 16101-3680
(757) 576-5479
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
NULL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Enumeration date
07/30/2019
Last updated
07/30/2019
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