Professional Dental Alliance of Colchester, PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

PROFESSIONAL DENTAL ALLIANCE OF COLCHESTER, PLLC

Practice address

151 Broadway St
Colchester, CT 06415-1056

Phone

(860) 537-1444

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 Colchester Doing business as

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": "1780175208",
    "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": "151 BROADWAY ST",
            "city": "COLCHESTER",
            "state": "CT",
            "postal_code": "064151056",
            "telephone_number": "860-537-1444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL DENTAL ALLIANCE OF COLCHESTER, 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 Colchester",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Natalia Pisklak
• Wendy Pizzoferrato, RN
• Barbara Pokorny, APRN
• Laura C Popeleski, PAC
• Priya Tandon M.D. LLC
• Joshua Pruitt, PHARM.D.
• Psychotherapy Associates of CT, LLC
• Susan Gene Pugatch, RPT
• Kelsey Rai, LMFTA
• Lori Raymond, ND

• General Practice Dentistry in Colchester, CT
• Providers in Colchester, 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.