Organization
PROFESSIONAL DENTAL ALLIANCE SPECIALTY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERICA QUINTEROS (CREDENTIALING)
(724) 901-1964
Entity
Organization
Contact information
Practice address
6540 SOUTH AVE, BOARDMAN, OH 44512-3651
(330) 721-0606
Mailing address
125 ENTERPRISE DR STE 200, PITTSBURGH, PA 15275-1223
(724) 698-2500
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
OH
1223E0200X
Endodontics
—
OH
1223G0001X
General Practice Dentistry
—
OH
1223P0106X
Oral and Maxillofacial Pathology Dentistry
—
OH
1223P0221X
Pediatric Dentistry
—
OH
1223P0300X
Periodontics
—
OH
1223P0700X
Prosthodontics
—
OH
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
OH
1223X0008X
Oral and Maxillofacial Radiology Dentistry
—
OH
122400000X
Denturist
—
OH
Other
Enumeration date
06/27/2011
Last updated
03/25/2024
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