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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