NPIMap

Organization Active NPI

Professional Dental Alliance

  • General Practice Dentistry
  • Shaker Heights, OH
National Provider Identifier
1508161779
Registry record updated Jan 20, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
30022469 Issued in OH
Legal business name
PROFESSIONAL DENTAL ALLIANCE
Practice address
12808 Drexmore Rd
Shaker Heights, OH 44120-5609
Phone
(216) 921-8888
Fax
(330) 533-2700
NPI assigned
Jan 20, 2011
Last updated
Jan 20, 2011By the provider in NPPES
Organization subpart
Yes
Parent organization
PROFESSIONAL DENTAL ALLIANCEAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 20, 2011

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

Authorized official

Name
Andrew S Matta, DMD
Title
Member
Phone
(330) 533-3400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 30022469 OH Primary

Addresses

Primary practice location

12808 Drexmore Rd
Shaker Heights, OH 44120-5609

Mailing address

3800 Boardman Canfield Rd
Canfield, OH 44406-9029
Phone (330) 533-3400

National Provider Directory

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

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": "1295481600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1295481600000",
    "number": "1508161779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3800 BOARDMAN CANFIELD RD",
            "city": "CANFIELD",
            "state": "OH",
            "postal_code": "444069029",
            "telephone_number": "330-533-3400",
            "fax_number": "330-533-2700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12808 DREXMORE RD",
            "city": "SHAKER HEIGHTS",
            "state": "OH",
            "postal_code": "441205609",
            "telephone_number": "216-921-8888",
            "fax_number": "330-533-2700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL DENTAL ALLIANCE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROFESSIONAL DENTAL ALLIANCE",
        "enumeration_date": "2011-01-20",
        "last_updated": "2011-01-20",
        "status": "A",
        "authorized_official_last_name": "MATTA",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "330-533-3400",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "30022469",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shaker Heights, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2011; 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.