Professional Dental Alliance of Shadyside, LLC

NPI #1124589585 in Shadyside, Ohio

Provider Information

NPI Number: 1124589585
Entity Type: Organization
Organization Name: Professional Dental Alliance of Shadyside, LLC
Primary Specialty: Dentist
Enumeration Date: Mar 28, 2019
Last Updated: Mar 28, 2019

Practice Location

Address: 3775 CENTRAL AVE
City: Shadyside
State: Ohio
ZIP Code: 43947-1344
Phone: (740) 676-2604

Authorized Official

Name: LAUREN HOWARD, MA
Title: CREDENTIALING SPECIALIST
Phone: (724) 698-2029

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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