NPIMap

Organization Active NPI

Professional Dental Alliance of Chillicothe, LLC

  • Dentist
  • Chillicothe, OH
National Provider Identifier
1962974709
Registry record updated Dec 18, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
PROFESSIONAL DENTAL ALLIANCE OF CHILLICOTHE, LLC
Practice address
1849 N Bridge St
Chillicothe, OH 45601-4110
Phone
(877) 959-5405
NPI assigned
Dec 18, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2018

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

Authorized official

Name
Lauren Howard, MA
Title
Credentialing Specialist
Phone
(724) 698-2029

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

1849 N Bridge St
Chillicothe, OH 45601-4110

Mailing address

11 S Mill St Ste 200
New Castle, PA 16101-3680
Phone (724) 698-2500

Other names 1

  • Stonecreek Dental Care Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Professional Dental Alliance of Chillicothe 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.

NPI Registry JSON

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

{
    "created_epoch": "1545091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1545091200000",
    "number": "1962974709",
    "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": "844-399-0385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1849 N BRIDGE ST",
            "city": "CHILLICOTHE",
            "state": "OH",
            "postal_code": "456014110",
            "telephone_number": "877-959-5405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL DENTAL ALLIANCE OF CHILLICOTHE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-18",
        "last_updated": "2018-12-18",
        "status": "A",
        "authorized_official_last_name": "HOWARD",
        "authorized_official_first_name": "LAUREN",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "724-698-2029",
        "authorized_official_credential": "MA"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stonecreek Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chillicothe, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 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.