Provider Demographics
NPI:1144914052
Name:PREMIER DENTAL ALLIANCE LLC
Entity type:Organization
Organization Name:PREMIER DENTAL ALLIANCE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:A
Authorized Official - Last Name:PARRY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:724-836-3368
Mailing Address - Street 1:234 SOUTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:HOMER CITY
Mailing Address - State:PA
Mailing Address - Zip Code:15748-1560
Mailing Address - Country:US
Mailing Address - Phone:724-349-3368
Mailing Address - Fax:724-717-6141
Practice Address - Street 1:1040 TOWNE SQUARE DR. SUITE 2
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-5769
Practice Address - Country:US
Practice Address - Phone:724-836-3368
Practice Address - Fax:724-836-1209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-05
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental