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General NPI Number Information
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NPI Number | 1437666120
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Entity Type | Organization
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Legal Business Name | GARDENDALE FAMILY DENTISTRY LLC
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Dates
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Enumeration Date | 01/04/2018
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Last Update Date | 01/04/2018
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Provider Practice Location Address
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Address Line | 2619 DECATUR HWY
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City | FULTONDALE
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State | AL
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Zip | 35068-1723
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Country | US
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Telephone | 205-631-7301
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Fax | 205-841-7496
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Provider Business Mailing Address
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Address Line | 2619 DECATUR HWY
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City | FULTONDALE
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State | AL
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Zip | 35068-1723
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Country | US
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Telephone | 205-631-7301
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Fax | 205-841-7496
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Authorized Official
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Title or Position | INSURANCE DEPARTMENT MANAGER
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Name | LASHEA DODSON
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Credential |
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Telephone | 205-647-3181
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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 | 5416
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License Number State | AL
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