Healthcare Provider Details

I. General information

NPI: 1801043708
Provider Name (Legal Business Name): SOLID ROCK DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2008
Last Update Date: 08/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20036 HIGHWAY 11
WOODSTOCK AL
35188-3733
US

IV. Provider business mailing address

20036 HIGHWAY 11
WOODSTOCK AL
35188-3733
US

V. Phone/Fax

Practice location:
  • Phone: 205-938-9727
  • Fax: 205-938-0324
Mailing address:
  • Phone: 205-938-9727
  • Fax: 205-938-0324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5506
License Number StateAL

VIII. Authorized Official

Name: DR. GREGORY W EGBERT
Title or Position: DENTIST
Credential: DMD
Phone: 205-938-9727