Healthcare Provider Details

I. General information

NPI: 1043405939
Provider Name (Legal Business Name): DUBE FAMILY DENTISTRY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2007
Last Update Date: 09/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 BANGOR AVE SE
HANCEVILLE AL
35277
US

IV. Provider business mailing address

PO 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 Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. PETER WADE DUBE
Title or Position: CEO
Credential:
Phone: 256-352-4422