Professional Dental Alliance of Defiance, LLC

NPI #1679093330 in Defiance, Ohio

Provider Information

NPI Number: 1679093330
Entity Type: Organization
Organization Name: Professional Dental Alliance of Defiance, LLC
Subpart: Yes (part of a larger organization)
Parent Organization: P O BOX 713770, CINCINNATI, OH 45271
Primary Specialty: Dentist - General Practice
Enumeration Date: Jun 23, 2017
Last Updated: Jun 23, 2017

Practice Location

Address: 100 STADIUM DR STE A
City: Defiance
State: Ohio
ZIP Code: 43512-4615
Phone: (419) 784-0775

Authorized Official

Name: ANDREW MATTA
Title: OWNER
Phone: (724) 698-2500

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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