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General NPI Number Information
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NPI Number | 1477199511
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Entity Type | Organization
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Legal Business Name | KENTROS DENTAL LLC
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Dates
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Enumeration Date | 11/25/2019
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Last Update Date | 11/25/2019
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Provider Practice Location Address
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Address Line | PELHAMDENTALCARE@OUTLOOK.COM 1973 CHANDALAR DRIVE
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City | PELHAM
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State | AL
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Zip | 35124
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Country | US
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Telephone | 205-663-6246
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Fax | 205-663-0242
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Provider Business Mailing Address
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Address Line | PELHAMDENTALCARE@OUTLOOK.COM 1973 CHANDALAR DRIVE
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City | PELHAM
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State | AL
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Zip | 35124
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Country | US
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Telephone | 205-663-6246
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Fax | 205-663-0242
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Authorized Official
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Title or Position | BUSINESS ADMIN
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Name | TAMIE L SMITH
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Credential |
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Telephone | 205-937-0746
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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