Provider Demographics
NPI:1407394380
Name:PROFESSIONAL DENTAL ALLIANCE OF HOPEWELL LLC
Entity Type:Organization
Organization Name:PROFESSIONAL DENTAL ALLIANCE OF HOPEWELL LLC
Other - Org Name:HOPEWELL DENTAL HEATH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-698-2500
Mailing Address - Street 1:11 S MILL ST
Mailing Address - Street 2:STE 200
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16101-3613
Mailing Address - Country:US
Mailing Address - Phone:724-698-2500
Mailing Address - Fax:
Practice Address - Street 1:572 INDUSTRIAL PKWY
Practice Address - Street 2:
Practice Address - City:HEATH
Practice Address - State:OH
Practice Address - Zip Code:43056-1528
Practice Address - Country:US
Practice Address - Phone:740-522-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROFESSIONAL DENTAL ALLAINCE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-02-10
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty