# PROFESSIONAL DENTAL ALLIANCE OF CENTERVILLE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124672092
- **Authorized official:** LAUREN HOWARD (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (757) 576-5479

## Contact information

- **Practice address:** 9420 DAYTON LEBANON PIKE, CENTERVILLE, OH 45458-3860
- **Practice address phone:** (937) 433-8900
- **Mailing address:** 11 S MILL ST STE 200, NEW CASTLE, PA 16101-3680
- **Mailing address phone:** (757) 576-5479

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 07/30/2019
- **Last updated:** 07/30/2019