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General NPI Number Information
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NPI Number | 1386015022
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Entity Type | Organization
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Legal Business Name | PROGRESSIVE DENTISTRY
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Dates
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Enumeration Date | 10/07/2015
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Last Update Date | 10/07/2015
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Provider Practice Location Address
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Address Line | 11093 AL HIGHWAY 71
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City | PISGAH
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State | AL
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Zip | 35765-7713
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Country | US
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Telephone | 256-451-7242
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Fax |
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Provider Business Mailing Address
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Address Line | 11093 AL HIGHWAY 71
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City | PISGAH
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State | AL
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Zip | 35765-7713
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Country | US
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Telephone | 256-451-7242
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DARREN PATRICK BARRILLEAUX
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Credential | DDS
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Telephone | 256-451-7242
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 4490
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License Number State | AL
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