Healthcare Provider Details

I. General information

NPI: 1164400669
Provider Name (Legal Business Name): ROBERT C PFEFFLE DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 12/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 GRELOT RD
MOBILE AL
36609-3603
US

IV. Provider business mailing address

5901 GRELOT RD
MOBILE AL
36609-3603
US

V. Phone/Fax

Practice location:
  • Phone: 251-344-6191
  • Fax: 251-344-6794
Mailing address:
  • Phone: 251-344-6191
  • Fax: 251-344-6794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number4598
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: