MEDICARE: DENTREMONT DENTAL SERVICES PC

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	4021	AL

General Provider Information

NPI Number	:	1629452636
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTREMONT DENTAL SERVICES PC

Provider Business Mailing Address
First Line	:	3501 GULF SHORES PKWY
Second Line	:	SUITE 4
City	:	GULF SHORES
State	:	AL
Zip	:	36542-5710
Country	:	US
Telephone Number	:	251-943-0004
Fax Number	:	844-208-8385

Provider Business Practice Location Address
First Line	:	3501 GULF SHORES PKWY
Second Line	:	SUITE 4
City	:	GULF SHORES
State	:	AL
Zip	:	36542-5710
Country	:	US
Telephone Number	:	251-943-0004
Fax Number	:	844-208-8385

Authorized Official
Title or Position	:	OWNER
Name	:	DR. FRANKLIN ALCIDE DENTREMONT JR.
Credential	:	DMD
Telephone Number	:	251-943-0004

Provider Enumeration Date	:	07/20/2015
Last Update Date	:	11/09/2016

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