MEDICARE: WASHBURN FAMILY DENTAL CARE, INC

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	5120	AL
2	122300000X	Dentist	5247	AL

General Provider Information

NPI Number	:	1487189528
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WASHBURN FAMILY DENTAL CARE, INC

Provider Business Mailing Address
First Line	:	2164 MOORES MILL RD
Second Line	:
City	:	AUBURN
State	:	AL
Zip	:	36830-8447
Country	:	US
Telephone Number	:	334-750-5720
Fax Number	:	334-209-0515

Provider Business Practice Location Address
First Line	:	2164 MOORES MILL RD
Second Line	:
City	:	AUBURN
State	:	AL
Zip	:	36830-8447
Country	:	US
Telephone Number	:	334-750-5720
Fax Number	:	334-209-0515

Authorized Official
Title or Position	:	DOCTOR/OWNER
Name	:	DR. ERNEST JASON WASHBURN
Credential	:	DMD
Telephone Number	:	334-750-5720

Provider Enumeration Date	:	04/26/2017
Last Update Date	:	04/26/2017

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