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General NPI Number Information
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NPI Number | 1174867014
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Entity Type | Organization
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Legal Business Name | PERIODONTAL AND IMPLANT ASSOCIATES, INC.
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Dates
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Enumeration Date | 11/15/2012
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Last Update Date | 11/15/2012
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Provider Practice Location Address
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Address Line | 212 4TH AVE SE SUITE 500
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City | CULLMAN
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State | AL
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Zip | 35055-3673
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Country | US
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Telephone | 256-734-8588
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Fax |
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Provider Business Mailing Address
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Address Line | 212 4TH AVE SE SUITE 500
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City | CULLMAN
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State | AL
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Zip | 35055-3673
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Country | US
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Telephone | 256-734-8588
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Fax |
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Authorized Official
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Title or Position | OWNER/PERIODONTIST
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Name | DR. JENNIFER H DOOBROW
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Credential | DMD
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Telephone | 256-734-8588
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 5578
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License Number State | AL
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