Professional Dental Alliance of Centerville, LLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Legal business name

PROFESSIONAL DENTAL ALLIANCE OF CENTERVILLE, LLC

Practice address

9420 Dayton Lebanon Pike
Centerville, OH 45458-3860

Phone

(937) 433-8900

NPI assigned

Jul 30, 2019

Organization subpart

No

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

Authorized official

Name

Lauren Howard

Title

Credentialing Specialist

Phone

(757) 576-5479

Specialties & licenses 1

Addresses

Tax ID family

Professional Dental Alliance of Centerville LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Professional Dental Alliance of Centerville, LLC

  • Dentist
  • Centerville, OH
  • NPI 1922572072
  NPD tax ID

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

{
    "created_epoch": "1564444800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1564444800000",
    "number": "1124672092",
    "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",
            "telephone_number": "757-576-5479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9420 DAYTON LEBANON PIKE",
            "city": "CENTERVILLE",
            "state": "OH",
            "postal_code": "454583860",
            "telephone_number": "937-433-8900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL DENTAL ALLIANCE OF CENTERVILLE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-30",
        "last_updated": "2019-07-30",
        "status": "A",
        "authorized_official_last_name": "HOWARD",
        "authorized_official_first_name": "LAUREN",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "757-576-5479"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Premier Integrated Medical Assoc LTD
• Premier Integreated Medical Assoc LTD
• Premier Plastic Surgery and Dermatology Associates, LTD
• Ashley Taylor Prine
• Keianna Proctor
• Professional Dental Alliance of Centerville, LLC
• David Propst, D.O.
• Providence Medical Group Inc
• Cherish Joy Prutzman, M.D
• Prymekare, LLC

• Oral and Maxillofacial Surgery (Dentist) in Centerville, OH
• Providers in Centerville, OH by specialty
• Oral and Maxillofacial Surgery (Dentist) in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 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.