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General NPI Number Information
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NPI Number | 1154974277
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Entity Type | Organization
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Legal Business Name | CAMELLIA DENTAL CARE LLC
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Dates
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Enumeration Date | 07/17/2019
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Last Update Date | 07/17/2019
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Provider Practice Location Address
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Address Line | 1800 MCFARLAND BLVD N STE 230
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City | TUSCALOOSA
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State | AL
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Zip | 35406-2179
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Country | US
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Telephone | 205-345-1136
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Fax |
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Provider Business Mailing Address
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Address Line | 3985 PARKWOOD RD STE 109 #203
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City | BESSEMER
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State | AL
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Zip | 35022-5691
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Country | US
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Telephone | 205-292-0036
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Fax |
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | TIMOTHY GEORGE HOLLAND
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Credential | MBA
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Telephone | 205-292-0036
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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 |
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License Number State |
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