Healthcare Provider Details

I. General information

NPI: 1134598246
Provider Name (Legal Business Name): COVE FAMILY DENTISTRY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2015
Last Update Date: 04/26/2023
Certification Date: 04/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6707 HIGHWAY 431 S STE 103
OWENS CROSS ROADS AL
35763-9299
US

IV. Provider business mailing address

6707 HIGHWAY 431 S STE 103
OWENS CROSS ROADS AL
35763-9299
US

V. Phone/Fax

Practice location:
  • Phone: 256-534-1475
  • Fax: 256-533-1425
Mailing address:
  • Phone: 256-534-1475
  • Fax: 256-533-1425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number6157
License Number StateAL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. ELIZABETH ELLEN DULING
Title or Position: MEMBER
Credential: DMD
Phone: 256-534-1475