Healthcare Provider Details

I. General information

NPI: 1053987669
Provider Name (Legal Business Name): ALABAMA DENTAL MANAGEMENT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2021
Last Update Date: 06/03/2021
Certification Date: 06/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

274 N 3RD ST
GADSDEN AL
35901-3201
US

IV. Provider business mailing address

274 N 3RD ST
GADSDEN AL
35901-3201
US

V. Phone/Fax

Practice location:
  • Phone: 256-459-5309
  • Fax:
Mailing address:
  • Phone: 256-459-5309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code292200000X
TaxonomyDental Laboratory
License Number
License Number State

VIII. Authorized Official

Name: LAUREN CRANFORD
Title or Position: PRACTICE MANAGER
Credential:
Phone: 256-459-5309