# PROFESSIONAL DENTAL ALLIANCE OF MICHIGAN, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Refresh Dental Center Line
- **Organization subpart:** No

## Provider details

- **NPI number:** 1942740337
- **Authorized official:** MARIA JONES (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (724) 698-2132

## Contact information

- **Practice address:** 23845 VAN DYKE AVE, CENTER LINE, MI 48015-1300
- **Practice address phone:** (586) 467-0063
- **Mailing address:** 11 S MILL ST, SUITE 200, NEW CASTLE, PA 16101-3613
- **Mailing address phone:** (724) 698-2500

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | NULL | Yes |
| 122300000X | Dentist | — | — | Yes |

## Other

- **Enumeration date:** 03/03/2017
- **Last updated:** 03/13/2017