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General NPI Number Information
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NPI Number | 1477247591
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Entity Type | Organization
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Legal Business Name | JDSM ENTERPRISES LLC
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Dates
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Enumeration Date | 06/05/2023
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Last Update Date | 06/05/2023
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Provider Practice Location Address
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Address Line | 333 N COLLEGE ST
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City | AUBURN
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State | AL
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Zip | 36830-3814
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Country | US
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Telephone | 334-821-2404
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Fax |
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Provider Business Mailing Address
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Address Line | 3305 FOREST GLEN DR SW
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City | DECATUR
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State | AL
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Zip | 35603-1287
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Country | US
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Telephone | 205-563-4162
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Fax |
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Authorized Official
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Title or Position | DENTIST/2OWNER
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Name | DR. JOSHUA A DRAKE
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Credential | DMD
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Telephone | 205-563-4162
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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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