Healthcare Provider Details

I. General information

NPI: 1811229891
Provider Name (Legal Business Name): AFFORDABLE FAMILY DENTISTRY P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2010
Last Update Date: 02/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1096 COUNTRY ROAD 1579
CULLMAR AL
35058
US

IV. Provider business mailing address

P.O. BOX 353
HANCEVILLE AL
35077
US

V. Phone/Fax

Practice location:
  • Phone: 256-352-4422
  • Fax:
Mailing address:
  • Phone: 256-352-4422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5072
License Number StateAL

VIII. Authorized Official

Name: MR. PETER WADE DUBE I
Title or Position: CEO
Credential: D.M.D.
Phone: 256-352-4422