MEDICARE: PRECISION DENTAL

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	1223P0700X	Prosthodontics	5650	AL

General Provider Information

NPI Number	:	1417250937
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRECISION DENTAL

Provider Business Mailing Address
First Line	:	4730 CHACE CIR
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35244-3703
Country	:	US
Telephone Number	:	205-402-0105
Fax Number	:

Provider Business Practice Location Address
First Line	:	4730 CHACE CIR
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35244-3703
Country	:	US
Telephone Number	:	205-402-0105
Fax Number	:

Authorized Official
Title or Position	:	PROSTHODONTIST
Name	:	DR. BENJAMIN CHAPIN WADSWORTH
Credential	:	D.M.D
Telephone Number	:	205-402-0105

Provider Enumeration Date	:	12/07/2010
Last Update Date	:	12/07/2010

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