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General NPI Number Information
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NPI Number | 1215548896
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Entity Type | Individual
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Provider Name | ALEXANDER BRADEN PLAGENHOEF DDS
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Gender | Male
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Dates
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Enumeration Date | 08/16/2020
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Last Update Date | 08/16/2020
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Provider Practice Location Address
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Address Line | 116 WATTERSON PKWY
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City | TRUSSVILLE
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State | AL
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Zip | 35173-2306
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Country | US
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Telephone | 205-655-7774
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Fax |
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Provider Business Mailing Address
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Address Line | 701 LINDEN ST
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City | TRUSSVILLE
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State | AL
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Zip | 35173-3228
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Country | US
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Telephone | 334-790-5152
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D.0006798-C1
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License Number State | AL
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