Provider Demographics
NPI:1649762543
Name:PROFESSIONAL DENTAL ALLIANCE OF HEATH, LLC
Entity Type:Organization
Organization Name:PROFESSIONAL DENTAL ALLIANCE OF HEATH, LLC
Other - Org Name:HOPEWELL DENTAL HEATH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CMO/DMD
Authorized Official - Prefix:
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 STE 200
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16101-3680
Mailing Address - Country:US
Mailing Address - Phone:724-698-2500
Mailing Address - Fax:724-652-4619
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?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-06
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty