Healthcare Provider Details

I. General information

NPI: 1437074515
Provider Name (Legal Business Name): LIVE DENTAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7309 US HIGHWAY 80
HOPE HULL AL
36043-6825
US

IV. Provider business mailing address

7309 US HIGHWAY 80
HOPE HULL AL
36043-6825
US

V. Phone/Fax

Practice location:
  • Phone: 334-741-2414
  • Fax:
Mailing address:
  • Phone: 334-741-2414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SHIRLEY JENNIFER DANIEL
Title or Position: DENTIST
Credential: DDS
Phone: 678-739-6437