Organization
PROFESSIONAL DENTAL ALLIANCE OF DEFIANCE, LLC
Active
Parent organization
P O BOX 713770, CINCINNATI, OH 45271
Other names
Whittaker Dental Care Defiance
Organization subpart
Yes
Provider details
NPI number
Legal business name
P O BOX 713770, CINCINNATI, OH 45271
Authorized official
ANDREW MATTA (OWNER)
(724) 698-2500
Entity
Organization
Contact information
Practice address
100 STADIUM DR STE A, DEFIANCE, OH 43512-4615
(419) 784-0775
Mailing address
11 S MILL ST STE 200, NEW CASTLE, PA 16101-3680
(724) 698-2500
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
06/23/2017
Last updated
06/23/2017
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