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General NPI Number Information
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NPI Number | 1134653801
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Entity Type | Organization
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Legal Business Name | GADSDEN ORTHODONTICS, PC
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Dates
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Enumeration Date | 04/19/2017
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Last Update Date | 04/19/2017
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Provider Practice Location Address
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Address Line | 315 S 4TH ST
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City | GADSDEN
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State | AL
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Zip | 35901-5212
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Country | US
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Telephone | 256-543-1285
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Fax |
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Provider Business Mailing Address
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Address Line | 315 S 4TH ST
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City | GADSDEN
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State | AL
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Zip | 35901-5212
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Country | US
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Telephone | 256-543-1285
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Fax |
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Authorized Official
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Title or Position | OWNER,PRESIDENT
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Name | DR. CATHERINE ELLIS HAYNIE
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Credential | DMD
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Telephone | 256-504-9638
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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 | 5829
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License Number State | AL
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