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
—
—
Other
Enumeration date
07/30/2019
Last updated
07/30/2019
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