PROFESSIONAL DENTAL ALLIANCE OF CENTERVILLE, LLC (NPI# 1124672092) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124672092 |
| Entity Type | Organization |
| Organization Name | PROFESSIONAL DENTAL ALLIANCE OF CENTERVILLE, LLC |
| Practice Address |
9420 Dayton Lebanon Pike Centerville OH 45458-3860 |
| Mailing Address |
11 S Mill St Ste 200 New Castle PA 16101-3680 |
| Practice Telephone | 9374338900 |
| Mailing Telephone | 7575765479 |
| Enumeration Date | 2019-07-30 |
| Last Update Date | 2019-07-30 |
| Authorized Official Name | LAUREN HOWARD (CREDENTIALING SPECIALIST) |
| Authorized Official Telephone | 7575765479 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
Dental Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922572072 | Professional Dental Alliance of Centerville, LLC | Dentist | 9420 Dayton Lebanon Pike, Centerville, OH 45458-3860 | 2019-01-11 |
| Street Address |
9420 DAYTON LEBANON PIKE |
| City | CENTERVILLE |
| State | OH |
| Zip Code | 45458-3860 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619323243 | Nathan Justice | Dentist | 9420 Dayton Lebanon Pike, Centerville, OH 45458-3860 | 2016-05-12 |
| 1922572072 | Professional Dental Alliance of Centerville, LLC | Dentist | 9420 Dayton Lebanon Pike, Centerville, OH 45458-3860 | 2019-01-11 |
| 1578090544 | Ethan Mark Jones | Dentist | 9420 Dayton Lebanon Pike, Centerville, OH 45458-3860 | 2017-05-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255948170 | John M Duchak Md Cardiology LLC | Specialist | 1036 Wild Hickory Lane, Centerville, OH 45458 | 2020-09-24 |
| 1942833389 | Colleen Stevens | Counselor | 955 Sweeney Drive, Dayton, OH 45458 | 2020-02-13 |
| 1740770197 | Social Row Transitional Care, Inc. | Skilled Nursing Facility | 250 West Social Row Road, Centerville, OH 45458 | 2018-05-11 |
| 1326568833 | Mary Ann Horton | Registered Nurse | 1362 Hickoryview Ct, Dayton, OH 45458 | 2017-06-26 |
| 1487101911 | Brianna Burkman | Specialist/Technologist | 1400 Stone Ash Ct, Centerville, OH 45458 | 2016-09-01 |
| 1720434707 | Ascent Health, LLC | Community/Behavioral Health | 1162 Peachcreek Rd., Dayton, OH 45458 | 2016-05-10 |
| 1821450206 | Chi Living Communties | Skilled Nursing Facility | 1050 St. Leonard Way, Centerville, OH 45458 | 2016-03-24 |
| 1265842835 | Amanda Powell | Physical Therapist | 9582 Tahoe Drive, Centerville, OH 45458 | 2014-05-05 |
| 1255774337 | Rita Charlene Penley | Counselor | 99 South Main St, Centerville, OH 45458 | 2013-04-09 |
| 1447503933 | Martha Ann Sheldrick | Nurse Practitioner | 212 Walnut Grove Dr, Centerville, OH 45458 | 2012-10-21 |
| Find all providers in zip 45458 | ||||
| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689783334 | Robert Paul Hendricksen | Dentist | 7265 Far Hills Ave, Centerville, OH 45459-4206 | 2006-08-29 |
| 1538330089 | Kernan Oral Maxillofacial & Implant Surgery | Dentist | 9995 Dayton Lebanon Pike, Centerville, OH 45458 | 2008-03-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740846559 | Daniel Schwartz, Dmd, Md, LLC | Dentist | 23250 Chagrin Blvd Ste 205, Beachwood, OH 44122-5416 | 2019-05-16 |
| 1649834144 | William W. Francis Dds, LLC | Dentist | 27500 Detroit Rd Ste 104, Suite 104, Westlake, OH 44145-5913 | 2019-04-30 |
| 1346643749 | Emil D. Poporad, Dds | Dentist | 4124 Fulton Rd. N.w., Suite 102, Canton, OH 44718 | 2014-09-30 |
| 1285041186 | Ahmad Ali Millwala Dmd Oral and Maxillofacial Surgery Co | Dentist | 2846 Double Eagle Dr, Beavercreek, OH 45431-4709 | 2014-07-14 |
| 1427489566 | Thomas Gerosky, D.m.d. Inc | Dentist | 215 Miller Road, Avon Lake, OH 44012 | 2013-11-27 |
| 1346685195 | Matthew Thomas Marshall | Dentist | 3075 Smith Rd Ste 102, Fairlawn, OH 44333-4453 | 2013-05-07 |
| 1629329198 | Amherst Oral Surgery and Implant Center LLC | Dentist | 550 N Leavitt Rd, Amherst, OH 44001-1131 | 2012-09-25 |
| 1568710655 | Manraj S. Bath, Dds, Inc. | Dentist | 1575 Cross Creeks Blvd., Pickerington, OH 43147 | 2012-08-21 |
| 1467707018 | Matthew Aaron Popper | Dentist | 5825 Landerbrook Dr Ste 125, Cleveland, OH 44124 | 2012-07-19 |
| 1548534415 | Bushey Oral and Maxillofacial Surgery, Inc. | Dentist | 7081 West Blvd., Suite 1, Youngstown, OH 44512 | 2012-02-24 |
| Find all providers with the same taxonomy | ||||
| City | CENTERVILLE |
| Zip Code | 45458 |
Please comment or provide details below to improve the information on PROFESSIONAL DENTAL ALLIANCE OF CENTERVILLE, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.