Healthcare Provider Details

I. General information

NPI: 1902687114
Provider Name (Legal Business Name): VIBE HUNTSVILLE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2023
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1807 UNIVERSITY DR NW
HUNTSVILLE AL
35801-5744
US

IV. Provider business mailing address

1807 UNIVERSITY DR NW
HUNTSVILLE AL
35801-5744
US

V. Phone/Fax

Practice location:
  • Phone: 256-536-7414
  • Fax: 256-536-7471
Mailing address:
  • Phone: 256-536-7414
  • Fax: 256-536-7471

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: KIM WHITE
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 615-512-1839