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General NPI Number Information
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NPI Number | 1265946768
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Entity Type | Organization
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Legal Business Name | SUMITON FAMILY DENTISTRY, LLC
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Dates
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Enumeration Date | 11/21/2017
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Last Update Date | 11/21/2017
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Provider Practice Location Address
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Address Line | 385 BRYAN RD STE 300
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City | SUMITON
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State | AL
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Zip | 35148-3440
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Country | US
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Telephone | 205-648-6054
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Fax | 205-648-3625
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Provider Business Mailing Address
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Address Line | 385 BRYAN RD STE 300
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City | SUMITON
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State | AL
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Zip | 35148-3440
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Country | US
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Telephone | 205-647-3181
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Fax | 205-647-7375
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Authorized Official
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Title or Position | INSURANCE DEPARTMENT MANAGER
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Name | BEVERLY LASHEA DODSON
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Credential |
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Telephone | 205-647-3181
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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 |
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License Number State | AL
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