Professional Dental Alliance of Defiance, LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

PROFESSIONAL DENTAL ALLIANCE OF DEFIANCE, LLC

Doing business as

Whittaker Dental Care Defiance

Practice address

100 Stadium Dr Ste a
Defiance, OH 43512-4615

Phone

(419) 784-0775

NPI assigned

Jun 23, 2017

Last updated

Jun 23, 2017By the provider in NPPES

Organization subpart

Yes

Parent organization

P O BOX 713770, CINCINNATI, OH 45271As reported in NPPES

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

Addresses

Other names 1

• Whittaker Dental Care Defiance Doing business as

Part of

Professional Dental Alliance of Defiance LLC

Locations

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

{
    "created_epoch": "1498176000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1498176000000",
    "number": "1679093330",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 STADIUM DR STE A",
            "city": "DEFIANCE",
            "state": "OH",
            "postal_code": "435124615",
            "telephone_number": "419-784-0775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL DENTAL ALLIANCE OF DEFIANCE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "P O BOX 713770, CINCINNATI, OH 45271",
        "enumeration_date": "2017-06-23",
        "last_updated": "2017-06-23",
        "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": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Whittaker Dental Care Defiance",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• General Practice Dentistry in Defiance, OH
• Providers in Defiance, OH by specialty
• General Practice Dentistry in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 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.