Provider Demographics
NPI:1982398806
Name:PREMIER DENTAL ALLIANCE LLC
Entity Type:Organization
Organization Name:PREMIER DENTAL ALLIANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:A
Authorized Official - Last Name:PARRY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:724-836-3368
Mailing Address - Street 1:211 LAUREL AVE
Mailing Address - Street 2:
Mailing Address - City:CRESSON
Mailing Address - State:PA
Mailing Address - Zip Code:16630-1118
Mailing Address - Country:US
Mailing Address - Phone:814-886-5406
Mailing Address - Fax:814-886-5547
Practice Address - Street 1:211 LAUREL AVE
Practice Address - Street 2:
Practice Address - City:CRESSON
Practice Address - State:PA
Practice Address - Zip Code:16630-1118
Practice Address - Country:US
Practice Address - Phone:814-886-5406
Practice Address - Fax:814-886-5547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental