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General NPI Number Information
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NPI Number | 1063618528
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Entity Type | Organization
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Legal Business Name | AUBURN PEDIATRIC DENTISTRY
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Dates
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Enumeration Date | 06/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 841 NORTH DEAN ROAD
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City | AUBURN
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State | AL
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Zip | 36830
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Country | US
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Telephone | 334-826-6651
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Fax | 334-826-6657
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Provider Business Mailing Address
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Address Line | 841 NORTH DEAN ROAD
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City | AUBURN
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State | AL
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Zip | 36830
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Country | US
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Telephone | 334-826-6651
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Fax | 334-826-6657
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Authorized Official
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Title or Position | OWNER, DENTIST
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Name | DR. CHARLES REW GREENLEAF
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Credential | DMD
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Telephone | 334-826-6651
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 5385
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License Number State | AL
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