NPIMap

Organization Active NPI

Professional Dental Alliance, LLC

  • Dentist
  • Columbus, OH
National Provider Identifier
1356882989
Registry record updated Mar 15, 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 Westerville
Practice address
1730 Schrock Rd
Columbus, OH 43229-1575
Phone
(614) 890-3590
Fax
(614) 890-3597
NPI assigned
Mar 15, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2017

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

Authorized official

Name
Andrew Matta
Title
Owner
Phone
(724) 698-2500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

1730 Schrock Rd
Columbus, OH 43229-1575

Mailing address

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

Other names 1

  • Refresh Dental Westerville 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

NPI Registry JSON

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

{
    "created_epoch": "1489536000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1489536000000",
    "number": "1356882989",
    "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",
            "fax_number": "724-652-4619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1730 SCHROCK RD",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432291575",
            "telephone_number": "614-890-3590",
            "fax_number": "614-890-3597"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL DENTAL ALLIANCE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-15",
        "last_updated": "2017-03-15",
        "status": "A",
        "authorized_official_last_name": "MATTA",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "724-698-2500"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Refresh Dental Westerville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Columbus, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 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.