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General NPI Number Information
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NPI Number | 1376991885
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Entity Type | Organization
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Legal Business Name | RUFFNER MOUNTAIN RESTORATION DENTAL, LLC
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Dates
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Enumeration Date | 05/25/2016
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Last Update Date | 06/08/2016
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Provider Practice Location Address
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Address Line | 2806 RUFFNER RD 202
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City | IRONDALE
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State | AL
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Zip | 35210-3926
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Country | US
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Telephone | 205-851-4281
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Fax | 205-851-4282
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Provider Business Mailing Address
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Address Line | 2806 RUFFNER RD 202
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City | IRONDALE
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State | AL
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Zip | 35210-3926
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Country | US
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Telephone | 205-851-4281
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Fax | 205-851-4282
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Authorized Official
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Title or Position | DENTIST
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Name | DR. G JARI ROLLE
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Credential | DMD
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Telephone | 205-851-4281
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 5637
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License Number State | AL
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