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Organization
PROFESSIONAL DENTAL ALLIANCE OF ATLANTA BOULEVARD SE, LLC
Active
Organization
PROFESSIONAL DENTAL ALLIANCE OF ATLANTA BOULEVARD SE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAUREN HOWARD MA (CREDENTIALING SPECIALIST)
(724) 698-2029
Entity
Organization
Contact information
Practice address
465 BOULEVARD SE STE 207A, ATLANTA, GA 30312-3483
(404) 624-1230
Mailing address
11 S MILL ST STE 200, NEW CASTLE, PA 16101-3680
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
05/06/2019
Last updated
05/06/2019
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