Provider Demographics
NPI:1518499359
Name:ALLIANCE DENTAL III LLC
Entity Type:Organization
Organization Name:ALLIANCE DENTAL III LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NORM
Authorized Official - Middle Name:
Authorized Official - Last Name:WES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-592-6995
Mailing Address - Street 1:PO BOX 3066
Mailing Address - Street 2:
Mailing Address - City:ELIDA
Mailing Address - State:OH
Mailing Address - Zip Code:45807-0066
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11440 LIPPELMAN RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-4098
Practice Address - Country:US
Practice Address - Phone:513-771-9190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-30
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty