Healthcare Provider Details

I. General information

NPI: 1821516907
Provider Name (Legal Business Name): TUSCALOOSA COUNTY HEALTH DEPT DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2017
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 HARGROVE RD E
TUSCALOOSA AL
35405-2612
US

IV. Provider business mailing address

201 MONROE ST STE 1600 RSA TOWER - CENTRALIZED BILLING UNIT
MONTGOMERY AL
36104-3721
US

V. Phone/Fax

Practice location:
  • Phone: 205-562-6900
  • Fax: 205-562-6903
Mailing address:
  • Phone: 334-206-7065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MS. ARNITA L. SHEPHERD
Title or Position: DIRECTOR, CRM
Credential: MSW
Phone: 334-206-7065