Professional Dental Alliance of Centerville, LLC

NPI #1124672092 in Centerville, Ohio

Provider Information

NPI Number: 1124672092
Entity Type: Organization
Organization Name: Professional Dental Alliance of Centerville, LLC
Primary Specialty: Dentist - Oral and Maxillofacial Surgery
Enumeration Date: Jul 30, 2019
Last Updated: Jul 30, 2019

Practice Location

Address: 9420 DAYTON LEBANON PIKE
City: Centerville
State: Ohio
ZIP Code: 45458-3860
Phone: (937) 433-8900

Authorized Official

Name: LAUREN HOWARD
Title: CREDENTIALING SPECIALIST
Phone: (757) 576-5479

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - Oral and Maxillofacial Surgery — Oral and Maxillofacial Surgery	1223S0112X	Primary

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