Healthcare Provider Details

I. General information

NPI: 1982907473
Provider Name (Legal Business Name): CGF DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2010
Last Update Date: 07/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10300 BAILEY COVE RD SE STE 4
HUNTSVILLE AL
35803-2635
US

IV. Provider business mailing address

10300 BAILEY COVE RD SE STE 4
HUNTSVILLE AL
35803-2635
US

V. Phone/Fax

Practice location:
  • Phone: 256-650-0724
  • Fax: 256-650-0872
Mailing address:
  • Phone: 256-650-0724
  • Fax: 256-650-0872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. CLIFTON FRAZIER JR.
Title or Position: PRESIDENT
Credential: DDS
Phone: 256-650-0724