NPIMap

Organization Active NPI

Professional Dental Alliance of Shadyside, LLC

  • Dentist
  • Shadyside, OH
National Provider Identifier
1124589585
Registry record updated Mar 28, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
PROFESSIONAL DENTAL ALLIANCE OF SHADYSIDE, LLC
Practice address
3775 Central Ave
Shadyside, OH 43947-1344
Phone
(740) 676-2604
NPI assigned
Mar 28, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Lauren Howard, MA
Title
Credentialing Specialist
Phone
(724) 698-2029

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

3775 Central Ave
Shadyside, OH 43947-1344

Mailing address

11 S Mill St Ste 200
New Castle, PA 16101-3680

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1553731200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1553731200000",
    "number": "1124589585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 S MILL ST STE 200",
            "city": "NEW CASTLE",
            "state": "PA",
            "postal_code": "161013680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3775 CENTRAL AVE",
            "city": "SHADYSIDE",
            "state": "OH",
            "postal_code": "439471344",
            "telephone_number": "740-676-2604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL DENTAL ALLIANCE OF SHADYSIDE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-28",
        "last_updated": "2019-03-28",
        "status": "A",
        "authorized_official_last_name": "HOWARD",
        "authorized_official_first_name": "LAUREN",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "724-698-2029",
        "authorized_official_credential": "MA"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shadyside, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.