Professional Dental Alliance of Old Saybrook, PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

PROFESSIONAL DENTAL ALLIANCE OF OLD SAYBROOK, PLLC

Practice address

711 Boston Post Rd
Old Saybrook, CT 06475-2125

Phone

(860) 388-0242

NPI assigned

May 21, 2018

Organization subpart

No

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

Authorized official

Name

Andrew Matta, DMD

Title

Cmo/Owner

Phone

(724) 698-2500

Specialties & licenses 1

Addresses

Other names 1

• Life Long Dental Care of Old Saybrook Doing business as

Locations

Practitioners 2

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

• Riley Gonnet

  • Dentist
  • Old Saybrook, CT
  • NPI 1376236810
  NPD (past)
• Artem Matatov

  • General Practice Dentistry
  • Old Saybrook, CT
  • NPI 1477220184
  NPD (past)

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

{
    "created_epoch": "1526860800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1526860800000",
    "number": "1235620774",
    "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": "724-698-2500",
            "fax_number": "724-652-4619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 BOSTON POST RD",
            "city": "OLD SAYBROOK",
            "state": "CT",
            "postal_code": "064752125",
            "telephone_number": "860-388-0242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL DENTAL ALLIANCE OF OLD SAYBROOK, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-21",
        "last_updated": "2018-05-21",
        "status": "A",
        "authorized_official_last_name": "MATTA",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "CMO/OWNER",
        "authorized_official_telephone_number": "724-698-2500",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Life Long Dental Care of Old Saybrook",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Deirdre Plyer, MSW
• Andrea Lynn Pollak, LMFT
• Chad Porterfield
• Portia Pendleton, LCSW LLC.
• Premier Medical Associates
• Project Courage, LLC
• Project Courage, LLC
• Noel Quinn
• Tracy E. Ransom, PSY.D.
• Carla Ratti, PHD

• General Practice Dentistry in Old Saybrook, CT
• Providers in Old Saybrook, CT by specialty
• General Practice Dentistry in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2018; 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.