MEDICARE: PELL CITY DENTAL CENTER, P.C.

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

General Provider Information

NPI Number	:	1700916608
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PELL CITY DENTAL CENTER, P.C.

Provider Business Mailing Address
First Line	:	1605 COGSWELL AVE
Second Line	:
City	:	PELL CITY
State	:	AL
Zip	:	35125-1644
Country	:	US
Telephone Number	:	205-884-2370
Fax Number	:	205-338-0971

Provider Business Practice Location Address
First Line	:	1605 COGSWELL AVE
Second Line	:
City	:	PELL CITY
State	:	AL
Zip	:	35125-1644
Country	:	US
Telephone Number	:	205-884-2370
Fax Number	:	205-338-0971

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SCOTT R BARNETT
Credential	:	DMD, FAGD
Telephone Number	:	205-884-2370

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	08/22/2020

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