Organization

Professional Dental Alliance

General Practice Dentistry in Shaker Heights, OH(View on Map)

Legal Business Name

Professional Dental Alliance

NPI Number

1508161779

NPI Type

Organization

Enumeration Date

01/20/2011

Specialties

(Taxonomies)

Code

1223G0001X

Primary Taxonomy

Yes

Licenses

State

Ohio

License Number

30022469

Contact
Information

Purpose

Mailing
Location

Address

3800 BOARDMAN CANFIELD RD
12808 DREXMORE RD

City

Canfield
Shaker Heights

State

OH
OH

Postal Code

44406-9029
44120-5609

Country

US
US

Telephone Number

(330) 533-3400
(216) 921-8888

Authorized Official

Name

Andrew Matta

Title or Position

MEMBER

Telephone Number

(330) 533-3400

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 01/20/2011

Provider Address

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