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General NPI Number Information
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NPI Number | 1245407436
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Entity Type | Organization
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Legal Business Name | KNOLLWOOD DENTAL GROUP
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Dates
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Enumeration Date | 05/15/2008
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Last Update Date | 05/15/2008
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Provider Practice Location Address
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Address Line | 5612 COTTAGE HILL RD
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City | MOBILE
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State | AL
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Zip | 36609-4211
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Country | US
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Telephone | 251-666-3982
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Fax |
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Provider Business Mailing Address
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Address Line | 5612 COTTAGE HILL RD
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City | MOBILE
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State | AL
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Zip | 36609-4211
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Country | US
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Telephone | 251-666-3982
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | KATIE MARSHALL
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Credential | R.D.H.
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Telephone | 251-666-3982
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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 | 3028
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License Number State | AL
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