Healthcare Provider Details

I. General information

NPI: 1306117486
Provider Name (Legal Business Name): HARVEST FAMILY DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2012
Last Update Date: 01/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5850 HIGHWAY 53 SUITE Y
HARVEST AL
35749-4301
US

IV. Provider business mailing address

5850 HIGHWAY 53 SUITE Y
HARVEST AL
35749-4301
US

V. Phone/Fax

Practice location:
  • Phone: 256-852-1100
  • Fax:
Mailing address:
  • Phone: 256-852-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5711
License Number StateAL

VIII. Authorized Official

Name: ANDREW WILLIAMSON
Title or Position: OWNER
Credential: D.M.D.
Phone: 256-466-9608