Healthcare Provider Details

I. General information

NPI: 1578239992
Provider Name (Legal Business Name): NKO DENTAL AL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2021
Last Update Date: 08/17/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 W MARKET ST
ATHENS AL
35611-2456
US

IV. Provider business mailing address

403 E COLLEGE ST
PULASKI TN
38478-4315
US

V. Phone/Fax

Practice location:
  • Phone: 256-232-3415
  • Fax: 256-230-2648
Mailing address:
  • Phone: 931-363-1388
  • Fax: 931-363-1388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State

VIII. Authorized Official

Name: KIM WHITE
Title or Position: REGIONAL MANAGER
Credential:
Phone: 615-512-1839