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General NPI Number Information
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NPI Number | 1114266558
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Entity Type | Organization
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Legal Business Name | GENERAL DENTISTRY AND SAME DAY DENTURE CLINIC,LLC
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Dates
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Enumeration Date | 02/05/2013
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Last Update Date | 02/05/2013
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Provider Practice Location Address
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Address Line | 940 GILBERT FERRY RD SE B
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City | ATTALLA
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State | AL
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Zip | 35954-3338
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Country | US
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Telephone | 256-845-3050
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Fax | 256-845-3057
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Provider Business Mailing Address
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Address Line | 1201 BRIARWOOD AVE SW
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City | FORT PAYNE
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State | AL
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Zip | 35967-8473
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Country | US
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Telephone | 256-845-3050
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Fax | 256-845-3057
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Authorized Official
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Title or Position | PRESIDENT/MEMBER
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Name | DR. JOSEPH C COX
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Credential | D.M.D.
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Telephone | 256-845-3050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 5489
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License Number State | AL
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