Professional Dental Alliance of Northford, PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

PROFESSIONAL DENTAL ALLIANCE OF NORTHFORD, PLLC

Practice address

1355 Middletown Ave
Northford, CT 06472-1382

Phone

(203) 484-0456

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 Northford 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": "1811488356",
    "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": "1355 MIDDLETOWN AVE",
            "city": "NORTHFORD",
            "state": "CT",
            "postal_code": "064721382",
            "telephone_number": "203-484-0456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL DENTAL ALLIANCE OF NORTHFORD, 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 Northford",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• McKeon Wellness Services LLC
• North Branford Schools
• Northford Family Dental
• Judith B Olsen, PHARMD
• Maria Jose Penedo Warren, LPCA
• Sandra Marie Pullo, APRN
• Noelle Ranfone, LCSW
• Julia Marie Ricardo, ATS
• Peter John Rothenberg, PH.D.
• Anthony Frank Salerno III

• All providers in Northford, CT
• 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.