Professional Dental Alliance Specialty, LLC

Primary specialty

EndodonticsTaxonomy code 1223E0200X

Legal business name

PROFESSIONAL DENTAL ALLIANCE SPECIALTY, LLC

Practice address

7131 Spring Meadows Dr W
Suite C
Holland, OH 43528-7939

Phone

(419) 865-7433

Fax

(419) 865-7680

NPI assigned

Aug 26, 2016

Organization subpart

No

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

Authorized official

Name

Maria Jones

Title

Cred Specialist

Phone

(724) 698-2132

Specialties & licenses 1

Addresses

Other names 1

• NWO Endodontics 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.

• John Nabil Nassif Estemalik, BSC, MSD

  • Periodontics
  • Holland, OH
  • NPI 1760723738
  NPD (past)
• Caroline Ghattas Ayoub, BDS, MSD

  • Endodontics
  • Holland, OH
  • NPI 1346660065
  NPD (past)

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

{
    "created_epoch": "1472169600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472169600000",
    "number": "1346796869",
    "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": "161013613",
            "telephone_number": "724-698-2132",
            "fax_number": "724-652-4619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7131 SPRING MEADOWS DR W",
            "address_2": "SUITE C",
            "city": "HOLLAND",
            "state": "OH",
            "postal_code": "435287939",
            "telephone_number": "419-865-7433",
            "fax_number": "419-865-7680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL DENTAL ALLIANCE SPECIALTY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-26",
        "last_updated": "2016-08-26",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "MARIA",
        "authorized_official_title_or_position": "CRED SPECIALIST",
        "authorized_official_telephone_number": "724-698-2132"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Endodontics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NWO Endodontics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jacklyn Elaine Petersen, LPN
• William Roger Peterson, DDS
• Katie Pilcher, M.ED., ED.S., NCSP
• Julie Poignon, ED.S
• Jordan Lei Poling
• Promedica Central Physicians
• Purple Cab Co, LLC
• Jessica D Queen, LPN
• R & F Inc.
• Racing for Recovery

• Endodontics in Holland, OH
• Providers in Holland, OH by specialty
• Endodontics in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2016; 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.