Healthcare Provider Details

I. General information

NPI: 1316088537
Provider Name (Legal Business Name): DENTAID DENTAL CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 PLEASANT VALLEY RD
MOBILE AL
36606-2162
US

IV. Provider business mailing address

2727 PLEASANT VALLEY RD
MOBILE AL
36606-2162
US

V. Phone/Fax

Practice location:
  • Phone: 251-473-5705
  • Fax: 251-479-4709
Mailing address:
  • Phone: 251-473-5705
  • Fax: 251-479-4709

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: MR. ROGER A FLESHMAN
Title or Position: CFO
Credential:
Phone: 504-737-0197