Healthcare Provider Details

I. General information

NPI: 1821537788
Provider Name (Legal Business Name): AL DENTAL PROFESSIONALS II PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2017
Last Update Date: 02/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1518 N BRINDLEE MOUNTAIN PKWY
ARAB AL
35016-5723
US

IV. Provider business mailing address

2505 21ST AVE S SUITE#204,
NASHVILLE TN
37212-5652
US

V. Phone/Fax

Practice location:
  • Phone: 256-586-3117
  • Fax: 256-586-3452
Mailing address:
  • Phone: 615-620-5990
  • Fax: 888-702-3012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN B DENTON
Title or Position: OWNER
Credential: DMD
Phone: 256-586-3117