Healthcare Provider Details

I. General information

NPI: 1225415771
Provider Name (Legal Business Name): OXFORD PEDIATRIC DENTAL ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2015
Last Update Date: 05/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1409 HAMRIC DR E
OXFORD AL
36203-1933
US

IV. Provider business mailing address

50 CROPWELL DR SUITE 1
PELL CITY AL
35128-7552
US

V. Phone/Fax

Practice location:
  • Phone: 205-338-4227
  • Fax: 205-338-5558
Mailing address:
  • Phone: 205-338-4227
  • Fax: 205-338-5558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD BAKER CHAMBLISS JR.
Title or Position: PARTNER
Credential: D.M.D
Phone: 205-338-4227