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General NPI Number Information
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NPI Number | 1013696202
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Entity Type | Organization
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Legal Business Name | DOTHAN ENDODONTIC ASSOCIATES, P.C.
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Dates
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Enumeration Date | 07/14/2023
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Last Update Date | 07/14/2023
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Provider Practice Location Address
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Address Line | 220 HEALTHWEST DR STE 1
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City | DOTHAN
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State | AL
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Zip | 36303-2047
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Country | US
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Telephone | 334-793-7687
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Fax |
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Provider Business Mailing Address
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Address Line | 220 HEALTHWEST DR STE 1
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City | DOTHAN
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State | AL
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Zip | 36303-2047
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRACTICE SUPPORT COORDINATOR
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Name | MALLORY PRICE
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Credential |
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Telephone | 251-422-4361
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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