Healthcare Provider Details

I. General information

NPI: 1316580046
Provider Name (Legal Business Name): AL DOTHAN DENTAL PROFESSIONALS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2019
Last Update Date: 07/30/2020
Certification Date: 07/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 METRO DR
DOTHAN AL
36303-1985
US

IV. Provider business mailing address

2505 21ST AVE S STE 204
NASHVILLE TN
37212-5652
US

V. Phone/Fax

Practice location:
  • Phone: 334-699-5555
  • Fax:
Mailing address:
  • Phone: 678-372-7358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: MARTHA J HARP
Title or Position: DIRECTOR, REVENUE CYCLE OPERATIONS
Credential:
Phone: 678-372-7358