Healthcare Provider Details

I. General information

NPI: 1912633900
Provider Name (Legal Business Name): AUBURN IMPLANT DENTISTRY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2022
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 N COLLEGE ST STE D
AUBURN AL
36830-3030
US

IV. Provider business mailing address

670 N COLLEGE ST STE D
AUBURN AL
36830-3030
US

V. Phone/Fax

Practice location:
  • Phone: 334-209-1352
  • Fax:
Mailing address:
  • Phone: 334-209-1352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. BRITANY FABIAN MATIN
Title or Position: PERIODONTIST/OWNER
Credential: DMD, MS
Phone: 334-209-1352