Healthcare Provider Details

I. General information

NPI: 1194654707
Provider Name (Legal Business Name): HWY 72 FAMILY & IMPLANT DENTISTRY OF MADISON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7690 HIGHWAY 72 W STE 101
MADISON AL
35758-9593
US

IV. Provider business mailing address

785 OLD HICKORY BLVD STE 100
BRENTWOOD TN
37027-4512
US

V. Phone/Fax

Practice location:
  • Phone: 256-864-2739
  • Fax:
Mailing address:
  • Phone:
  • 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: WHITNEY CORADINI
Title or Position: REVENUE CYCLE MANAGER
Credential:
Phone: 615-497-5629