Organization
PROFESSIONAL DENTAL ALLIANCE
Active
Other names
Professional Dental Alliance
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANDREW MATTA D.D.S. (CHIEF MEDICAL OFFICER)
(724) 674-2965
Entity
Organization
Contact information
Practice address
11201 SHAKER BLVD, 136, CLEVELAND, OH 44104-3869
(216) 368-7238
Mailing address
11 S MILL ST, NEW CASTLE, PA 16101-3613
(724) 698-2500
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
30-023665
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30023665
LICENSE NUMBER
OH
Enumeration date
03/25/2015
Last updated
03/25/2015
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