| Professional Dental Alliance | |
|
3729 Lee Rd Shaker Heights OH 44120-5103 | |
| (216) 751-9922 | |
| (330) 533-2700 |
| Full Name | Professional Dental Alliance |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 3729 Lee Rd, Shaker Heights, Ohio |
| Authorized Official Name and Position | Andrew S Matta (MEMBER) |
| Authorized Official Contact | 3305333400 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Professional Dental Alliance 3800 Boardman Canfield Rd Canfield OH 44406-9029 Ph: (330) 533-3400 | Professional Dental Alliance 3729 Lee Rd Shaker Heights OH 44120-5103 Ph: (216) 751-9922 |
| NPI Number | 1891090064 |
|---|---|
| Provider Enumeration Date | 01/20/2011 |
| Last Update Date | 01/20/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891090064 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 30022469 (Ohio) | Primary |
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