Healthcare Provider Details

I. General information

NPI: 1184140121
Provider Name (Legal Business Name): ACCESS DENTAL CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1621 WOLVERINE DR SE
DECATUR AL
35601-4933
US

IV. Provider business mailing address

1621 WOLVERINE DR SE
DECATUR AL
35601-4933
US

V. Phone/Fax

Practice location:
  • Phone: 256-431-3184
  • Fax:
Mailing address:
  • Phone: 256-431-3184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. JASSEN ALLEN ANTHONY
Title or Position: MEMBER
Credential: DMD
Phone: 256-431-3184