Provider Demographics
NPI:1346796869
Name:PROFESSIONAL DENTAL ALLIANCE SPECIALTY, LLC
Entity Type:Organization
Organization Name:PROFESSIONAL DENTAL ALLIANCE SPECIALTY, LLC
Other - Org Name:NWO ENDODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CRED SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-698-2132
Mailing Address - Street 1:11 S MILL ST STE 200
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16101-3613
Mailing Address - Country:US
Mailing Address - Phone:724-698-2132
Mailing Address - Fax:724-652-4619
Practice Address - Street 1:7131 SPRING MEADOWS DR W
Practice Address - Street 2:SUITE C
Practice Address - City:HOLLAND
Practice Address - State:OH
Practice Address - Zip Code:43528-7939
Practice Address - Country:US
Practice Address - Phone:419-865-7433
Practice Address - Fax:419-865-7680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-26
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty