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General NPI Number Information
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NPI Number | 1316580046
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Entity Type | Organization
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Legal Business Name | AL DOTHAN DENTAL PROFESSIONALS PC
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Dates
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Enumeration Date | 10/25/2019
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Last Update Date | 07/30/2020
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Provider Practice Location Address
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Address Line | 100 METRO DR
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City | DOTHAN
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State | AL
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Zip | 36303-1985
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Country | US
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Telephone | 334-699-5555
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Fax |
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Provider Business Mailing Address
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Address Line | 2505 21ST AVE S STE 204
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City | NASHVILLE
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State | TN
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Zip | 37212-5652
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Country | US
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Telephone | 678-372-7358
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Fax |
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Authorized Official
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Title or Position | DIRECTOR, REVENUE CYCLE OPERATIONS
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Name | MARTHA J HARP
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Credential |
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Telephone | 678-372-7358
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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