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 S MATTA DMD (MEMBER)
(330) 533-3400
Entity
Organization
Contact information
Practice address
6285 YOUNGSTOWN WARREN RD, NILES, OH 44446-4656
(330) 505-9224
(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
30022469
OH
1223P0221X
Pediatric Dentistry
Primary
30022469
OH
Other
Enumeration date
01/20/2011
Last updated
01/20/2011
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