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General NPI Number Information
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NPI Number | 1407651490
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Entity Type | Organization
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Legal Business Name | TRUSSVILLE ORTHO LLC
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Dates
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Enumeration Date | 02/14/2025
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Last Update Date | 02/14/2025
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Provider Practice Location Address
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Address Line | 4643 CAMP COLEMAN RD STE 101
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City | TRUSSVILLE
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State | AL
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Zip | 35173-2838
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Country | US
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Telephone | 205-537-3008
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Fax |
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Provider Business Mailing Address
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Address Line | 4643 CAMP COLEMAN RD STE 101
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City | TRUSSVILLE
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State | AL
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Zip | 35173-2838
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Country | US
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Telephone | 205-537-3008
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Fax |
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | KIM DOSS
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Credential |
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Telephone | 205-222-1430
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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