MEDICARE: ACCESS DENTAL CARE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry
2	122300000X	Dentist

General Provider Information

NPI Number	:	1184140121
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACCESS DENTAL CARE, LLC

Provider Business Mailing Address
First Line	:	1621 WOLVERINE DR SE
Second Line	:
City	:	DECATUR
State	:	AL
Zip	:	35601-4933
Country	:	US
Telephone Number	:	256-431-3184
Fax Number	:

Provider Business Practice Location Address
First Line	:	1621 WOLVERINE DR SE
Second Line	:
City	:	DECATUR
State	:	AL
Zip	:	35601-4933
Country	:	US
Telephone Number	:	256-431-3184
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	DR. JASSEN ALLEN ANTHONY
Credential	:	DMD
Telephone Number	:	256-431-3184

Provider Enumeration Date	:	08/22/2017
Last Update Date	:	07/21/2022

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Directions to “ACCESS DENTAL CARE, LLC ” Practice Location

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