Professional Dental Alliance LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

PROFESSIONAL DENTAL ALLIANCE LLC

Practice address

3800 Boardman Canfield Rd
Canfield, OH 44406-9029

Phone

(330) 533-3400

Fax

(330) 533-2700

NPI assigned

Feb 24, 2012

Organization subpart

No

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

Authorized official

Name

Andrew S Matta, DMD

Title

Dentist/Owner

Phone

(330) 533-3400

Specialties & licenses 1

Addresses

Other names 1

• PDA Non-Par Other name

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

{
    "created_epoch": "1330041600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1330041600000",
    "number": "1811261712",
    "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": "3800 BOARDMAN CANFIELD RD",
            "city": "CANFIELD",
            "state": "OH",
            "postal_code": "444069029",
            "telephone_number": "330-533-3400",
            "fax_number": "330-533-2700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL DENTAL ALLIANCE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-24",
        "last_updated": "2012-02-24",
        "status": "A",
        "authorized_official_last_name": "MATTA",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "330-533-3400",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PDA Non-Par",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Judith A Prickett, CNP, APRN
• Primary Care Specialists, Inc.
• Pro Family Chiropractic Center, LTD.
• Professional Dental Alliance
• Professional Dental Alliance
• Lisa M Provenza-Tabak, D.C.
• Psy Care Inc
• Psycare, Inc
• Martin Carl Raupple, DDS
• Brooke Angelique Recker, OTR/L

• General Practice Dentistry in Canfield, OH
• Providers in Canfield, 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 Feb 24, 2012; 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.