Professional Dental Alliance of Centerville, LLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

PROFESSIONAL DENTAL ALLIANCE OF CENTERVILLE, LLC

Practice address

9420 Dayton Lebanon Pike
Centerville, OH 45458-3860

Phone

(877) 959-5405

NPI assigned

Jan 11, 2019

Organization subpart

No

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

Authorized official

Name

Amanda Kurtz

Title

Lead Credentialing Specialist

Phone

(724) 698-2481

Specialties & licenses 1

Addresses

Tax ID family

Professional Dental Alliance of Centerville LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Professional Dental Alliance of Centerville, LLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Centerville, OH
  • NPI 1124672092
  NPD tax ID

Locations

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

{
    "created_epoch": "1547164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1751414400000",
    "number": "1922572072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 ENTERPRISE DR STE 200",
            "city": "PITTSBURGH",
            "state": "PA",
            "postal_code": "152751223",
            "telephone_number": "724-698-2500",
            "fax_number": "844-399-0385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9420 DAYTON LEBANON PIKE",
            "city": "CENTERVILLE",
            "state": "OH",
            "postal_code": "454583860",
            "telephone_number": "877-959-5405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL DENTAL ALLIANCE OF CENTERVILLE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-11",
        "last_updated": "2025-07-02",
        "certification_date": "2025-07-02",
        "status": "A",
        "authorized_official_last_name": "KURTZ",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "LEAD CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "724-698-2481"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Premier Integreated Medical Assoc LTD
• Premier Plastic Surgery and Dermatology Associates, LTD
• Ashley Taylor Prine
• Keianna Proctor
• Professional Dental Alliance of Centerville, LLC
• David Propst, D.O.
• Providence Medical Group Inc
• Cherish Joy Prutzman, M.D
• Prymekare, LLC
• Prymekare, LLC

• Dentist in Centerville, OH
• Providers in Centerville, OH by specialty
• Dentist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2025; 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.