NPIMap

Organization Active NPI

Professional Dental Alliance, LLC

Doing business as Refresh Dental Hebron

  • Dentist
  • Hebron, OH
National Provider Identifier
1215478706
Registry record updated Mar 16, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
PROFESSIONAL DENTAL ALLIANCE, LLC
Doing business as
Refresh Dental Hebron
Practice address
820 W Main St
Hebron, OH 43025-9033
Phone
(740) 928-0761
NPI assigned
Mar 16, 2017
Last updated
Mar 16, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2017

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

Authorized official

Name
Andrew Matta, DMD
Title
Owner
Phone
(724) 698-2119

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X NU Primary

Addresses

Primary practice location

820 W Main St
Hebron, OH 43025-9033

Mailing address

11 S Mill St
Suite 200
New Castle, PA 16101-3613
Phone (724) 698-2500

Other names 1

  • Refresh Dental Hebron Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Professional Dental Alliance LLC21 organizations share this tax ID, including this one

Other organizations with this tax ID 20

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

View all 20

Locations

820 W Main St
Hebron, OH 43025
Phone (740) 928-0761

NPI Registry JSON

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

{
    "created_epoch": "1489622400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1489622400000",
    "number": "1215478706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 S MILL ST",
            "address_2": "SUITE 200",
            "city": "NEW CASTLE",
            "state": "PA",
            "postal_code": "161013613",
            "telephone_number": "724-698-2500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 W MAIN ST",
            "city": "HEBRON",
            "state": "OH",
            "postal_code": "430259033",
            "telephone_number": "740-928-0761"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL DENTAL ALLIANCE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-16",
        "last_updated": "2017-03-16",
        "status": "A",
        "authorized_official_last_name": "MATTA",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "724-698-2119",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Refresh Dental Hebron",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hebron, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2017; 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.