=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376612200
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SKYLINE FAMILY DENTAL CARE PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/07/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3977 BURMA ROAD
-----------------------------------------------------
City | MOBILE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36693
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-666-0576
-----------------------------------------------------
Fax | 251-666-0571
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3977 BURMA ROAD
-----------------------------------------------------
City | MOBILE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36693
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-666-0576
-----------------------------------------------------
Fax | 251-666-0571
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT DENTIST
-----------------------------------------------------
Name | DR. DAVID CHRISTIAN SALTER
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 251-666-0576
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------