Professional Dental Alliance | |
6285 Youngstown Warren Rd Niles OH 44446-4656 | |
(330) 505-9224 | |
(330) 533-2700 |
Full Name | Professional Dental Alliance |
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Speciality | Dentist - Pediatric Dentistry |
Location | 6285 Youngstown Warren Rd, Niles, Ohio |
Authorized Official Name and Position | Andrew S Matta (MEMBER) |
Authorized Official Contact | 3305333400 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Professional Dental Alliance 3800 Boardman Canfield Rd Canfield OH 44406-9029 Ph: (330) 533-3400 | Professional Dental Alliance 6285 Youngstown Warren Rd Niles OH 44446-4656 Ph: (330) 505-9224 |
NPI Number | 1962707133 |
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Provider Enumeration Date | 01/20/2011 |
Last Update Date | 01/20/2011 |
Identifier | Type | State | Issuer |
---|---|---|---|
1962707133 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223G0001X | Dentist - General Practice | 30022469 (Ohio) | Secondary |
1223P0221X | Dentist - Pediatric Dentistry | 30022469 (Ohio) | Primary |
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