Organization
PROFESSIONAL DENTAL ALLIANCE
Active
Parent organization
PROFESSIONAL DENTAL ALLIANCE
Organization subpart
Yes
Provider details
NPI number
Legal business name
PROFESSIONAL DENTAL ALLIANCE
Authorized official
ANDREW MATTA DMD (MEMBER)
(330) 533-3400
Entity
Organization
Contact information
Practice address
6540 SOUTH AVE, BOARDMAN, OH 44512-3651
(330) 758-6165
(330) 533-2700
Mailing address
3800 BOARDMAN CANFIELD RD, CANFIELD, OH 44406-9029
(330) 533-3400
(330) 533-2700
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
30022469
OH
Other
Enumeration date
01/20/2011
Last updated
01/20/2011
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