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General NPI Number Information
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NPI Number | 1265946321
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Entity Type | Organization
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Legal Business Name | RONALD ALYN MACBETH DMD, LLC
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Dates
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Enumeration Date | 11/28/2017
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Last Update Date | 11/28/2017
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Provider Practice Location Address
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Address Line | 1045 BROADWAY PARK, SUITE 101
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City | BIRMINGHAM
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State | AL
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Zip | 35209-3520
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Country | US
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Telephone | 850-380-6814
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Fax | 850-380-6814
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Provider Business Mailing Address
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Address Line | 219 DEVON DR
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City | BIRMINGHAM
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State | AL
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Zip | 35209-4317
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Country | US
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Telephone | 850-380-6814
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | RONALD MACBETH
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Credential |
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Telephone | 850-380-6814
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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 | D6453
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License Number State | AL
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