PROFESSIONAL DENTAL ALLIANCE (NPI# 1790179992) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790179992 |
| Entity Type | Organization |
| Organization Name | PROFESSIONAL DENTAL ALLIANCE |
| Other Organization Name | PROFESSIONAL DENTAL ALLIANCE |
| Practice Address |
11201 Shaker Blvd 136 Cleveland OH 44104-3869 |
| Mailing Address |
11 S Mill St New Castle PA 16101-3613 |
| Practice Telephone | 2163687238 |
| Mailing Telephone | 7246982500 |
| Enumeration Date | 2015-03-25 |
| Last Update Date | 2015-03-25 |
| Authorized Official Name | DR. ANDREW MATTA (CHIEF MEDICAL OFFICER) |
| Authorized Official Telephone | 7246742965 |
| Authorized Official Credential | D.D.S. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 122300000X | Dentist | 30-023665 | OH | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OH | LICENSE NUMBER | 30023665 | 01 |
| Other Name | Type Code |
|---|---|
| Professional Dental Alliance | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407151673 | Professional Dental Alliance | Dentist | 7043 Pearl Rd, Middleburg Heights, OH 44130-4973 | 2011-01-20 |
| 1952606121 | Professional Dental Alliance | Dentist | 750 E Washington St, Suite A3, Medina, OH 44256-2196 | 2011-01-20 |
| 1457656621 | Professional Dental Alliance | Dentist | 6540 South Ave, Boardman, OH 44512-3651 | 2011-01-20 |
| 1962707133 | Professional Dental Alliance | Dentist | 6285 Youngstown Warren Rd, Niles, OH 44446-4656 | 2011-01-20 |
| 1508161779 | Professional Dental Alliance | Dentist | 12808 Drexmore Rd, Shaker Heights, OH 44120-5609 | 2011-01-20 |
| 1447555610 | Professional Dental Alliance | Dentist | 1951 State Route 59, Suite B, Kent, OH 44240-8128 | 2011-01-20 |
| 1083919252 | Professional Dental Alliance | Dentist | 99 Debartolo Pl, Boardman, OH 44512-7014 | 2011-01-20 |
| 1891090064 | Professional Dental Alliance | Dentist | 3729 Lee Rd, Shaker Heights, OH 44120-5103 | 2011-01-20 |
| 1770888943 | Professional Dental Alliance | Dentist | 721 S Union Ave, Alliance, OH 44601-2932 | 2011-01-20 |
| 1548565849 | Professional Dental Alliance | Dentist | 101 S Main St, Poland, OH 44514-2062 | 2011-01-18 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Connecticut Business Registrations | PROFESSIONAL DENTAL ALLIANCE OF BETHEL, PLLC | 11 South Mill Street, Suite 200, New Castle, PA 16101 |
| Connecticut Business Registrations | Professional Dental Alliance of Colchester, Pllc | 11 South Mill Street, Suite 200, New Castle, PA 16101 |
| Connecticut Business Registrations | PROFESSIONAL DENTAL ALLIANCE OF CONNECTICUT, PLLC | 11 South Mill St Ste 200, New Castle, PA 16101 |
| Connecticut Business Registrations | Professional Dental Alliance of Ct 07009 - 07014 Ortho, Pllc | 11 S. Mill St., Ste. 200, New Castle, PA 16101 |
| Connecticut Business Registrations | PROFESSIONAL DENTAL ALLIANCE OF CT 07009 - 07014 PEDS, PLLC | 11 S. Mill St., Ste. 200, New Castle, PA 16101 |
| Indiana Business Entities | PROFESSIONAL DENTAL ALLIANCE OF INDIANA, LLC | 11 S Mill St, Ste 200, New Castle, PA 16101 |
| Connecticut Business Registrations | PROFESSIONAL DENTAL ALLIANCE OF MILFORD, PLLC | 11 South Mill Street, Suite 200, New Castle, PA 16101 |
| New York State Corporations | PROFESSIONAL DENTAL ALLIANCE OF NEW YORK, PLLC | 80 State Street, Albany, Ny 122072543 |
| Connecticut Business Registrations | PROFESSIONAL DENTAL ALLIANCE OF NORTHFORD, PLLC | 11 South Mill Street, Suite 20, New Castle, PA 16101 |
| Connecticut Business Registrations | PROFESSIONAL DENTAL ALLIANCE OF NORWALK, PLLC | 11 South Mill Street, Suite 200, New Castle, PA 16101 |
| Street Address |
11201 SHAKER BLVD 136 |
| City | CLEVELAND |
| State | OH |
| Zip Code | 44104-3869 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861495236 | Angela M Bennett | Family Medicine | 11201 Shaker Blvd, Suite 102a, Cleveland, OH 44104 | 2005-05-31 |
| 1659997492 | Jalysa Blake | Case Manager/Care Coordinator | 11201 Shaker Blvd, Cleveland, OH 44104-3869 | 2020-06-17 |
| 1417572348 | Camille Horton | Case Manager/Care Coordinator | 11201 Shaker Blvd, Cleveland, OH 44104-3869 | 2020-06-16 |
| 1073136024 | Carol Range | Case Manager/Care Coordinator | 11201 Shaker Blvd, Cleveland, OH 44104-3869 | 2020-05-26 |
| 1265052179 | Brieana Wilson | Case Manager/Care Coordinator | 11201 Shaker Blvd, Cleveland, OH 44104-3869 | 2020-04-21 |
| 1851802615 | Aditi Parikh | Dentist | 11201 Shaker Blvd, Cleveland, OH 44104-3869 | 2017-10-19 |
| 1932610698 | Quentin Joh-douglas Montgomery | Dentist | 11201 Shaker Blvd, Cleveland, OH 44104 | 2017-10-19 |
| 1972952554 | Cleveland Accident Rehab, LLC | Chiropractor | 11201 Shaker Blvd, 322, Cleveland, OH 44104 | 2016-06-06 |
| 1003276106 | Cleveland Dental Institute LLC | Clinic/Center | 11201 Shaker Blvd, Cleveland, OH 44104-3869 | 2016-03-02 |
| 1336527340 | Lawrence Rossoff | Dentist | 11201 Shaker Blvd, #136, Cleveland, OH 44104-3869 | 2015-05-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619510419 | Gwen Burtin | Technician | 9908 Kennedy Ave, Cleveland, OH 44104 | 2019-10-24 |
| 1215422001 | Julia Shneyderman | Dentist | 11202 Shaker Blvd Ste 136, Cleveland, OH 44104 | 2018-06-25 |
| 1477058527 | Kwananda A Plato | Technician | 9717 Elwell Ave., Cleveland, OH 44104 | 2018-03-29 |
| 1073035887 | Tia Marie Heard | Home Health | 4591 Quincy Avenue Building Q, Cleveland, OH 44104 | 2017-07-13 |
| 1407306608 | Shelby Mcquiller | Social Worker | 2632 E 115th St, Cleveland, OH 44104 | 2016-10-11 |
| 1568852390 | Cleveland Arts & Social Sciences Academy | Psychologist | 10701 Shaker Blvd, Cleveland, OH 44104 | 2015-02-02 |
| 1164827705 | Eboni Danyale Jordan | Licensed Practical Nurse | 3143 East 99th, Cleveland, OH 44104 | 2014-10-24 |
| 1902224157 | Woodland Academy, Inc. | Local Education Agency (LEA) | 10615 Lamontier Blvd., Cleveland, OH 44104 | 2014-04-04 |
| 1467793778 | Teresa M Evans-guyton | Nurse Practitioner | 11201 Shaker Blvd Ste 240, Cleveland, OH 44104 | 2013-03-12 |
| 1023387057 | Roslyn Jeanette Carter | Home Health Aide | 9423 Ramona Blvd, Cleveland, OH 44104 | 2011-12-20 |
| Find all providers in zip 44104 | ||||
| Taxonomy Code | 122300000X |
| Grouping | Dental Providers |
| Classification | Dentist |
| A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770119539 | Cleveland Sleep Treatment LLC | Dentist | 3736 Rocky River Dr, Cleveland, OH 44111-4050 | 2020-03-12 |
| 1982255345 | Rest Assured LLC | Dentist | 4245 N Ocoee St Suite 4, Cleveland, TN 37312-4999 | 2019-09-26 |
| 1215422001 | Julia Shneyderman | Dentist | 11202 Shaker Blvd Ste 136, Cleveland, OH 44104 | 2018-06-25 |
| 1386164655 | Elisabeth Anna Banasik | Dentist | Case Western Reserve School of Dental Medicine, 2124 Cornell Road, Cleveland, OH 44106 | 2017-06-27 |
| 1467999102 | William Smith | Dentist | 9601 Chester Ave # 239j, Cleveland, OH 44106 | 2017-01-19 |
| 1407235872 | Dr. Yazan Haddadeen & Partners LLC | Dentist | 2906 Euclid Ave, Cleveland, OH 44115-2416 | 2015-05-19 |
| 1629489208 | Lutfi Nassar | Dentist | 5716 Broadway Ave., Cleveland, OH 44127 | 2014-05-16 |
| 1457799256 | Anne M. Clemons | Dentist | 9500 Euclid Ave # A-71, Cleveland, OH 44195-0001 | 2013-06-13 |
| 1285071829 | N. Stephen Wilson, D.d.s. | Dentist | 4635 Richmond Rd Ste 100, Cleveland, OH 44128-5938 | 2013-05-22 |
| 1194086645 | Zamira Jani | Dentist | 3084 W 25th St, Cleveland, OH 44113-5306 | 2012-05-31 |
| Find all providers in CLEVELAND | ||||
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| 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.