MEDICARE: DR. JONI PRICE

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	122300000X	Dentist	4685	AL

General Provider Information

NPI Number	:	1467475319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONI PRICE

Provider Business Mailing Address
First Line	:	139 ALIANT PARKWAY
Second Line	:
City	:	ALEXANDER CITY
State	:	AL
Zip	:	35010-2674
Country	:	US
Telephone Number	:	256-329-8401
Fax Number	:	256-329-3539

Provider Business Practice Location Address
First Line	:	139 ALIANT PARKWAY
Second Line	:
City	:	ALEXANDER CITY
State	:	AL
Zip	:	35010-2674
Country	:	US
Telephone Number	:	256-329-8401
Fax Number	:	256-329-3539

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	12/24/2007

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