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General NPI Number Information
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NPI Number | 1417250937
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Entity Type | Organization
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Legal Business Name | PRECISION DENTAL
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Dates
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Enumeration Date | 12/07/2010
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Last Update Date | 12/07/2010
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Provider Practice Location Address
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Address Line | 4730 CHACE CIR
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City | HOOVER
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State | AL
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Zip | 35244-3703
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Country | US
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Telephone | 205-402-0105
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Fax |
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Provider Business Mailing Address
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Address Line | 4730 CHACE CIR
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City | HOOVER
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State | AL
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Zip | 35244-3703
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Country | US
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Telephone | 205-402-0105
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Fax |
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Authorized Official
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Title or Position | PROSTHODONTIST
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Name | DR. BENJAMIN CHAPIN WADSWORTH
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Credential | D.M.D
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Telephone | 205-402-0105
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 5650
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License Number State | AL
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