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General NPI Number Information
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NPI Number | 1487817987
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Entity Type | Organization
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Legal Business Name | SOUTHERN DENTISTRY, P.C.
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Dates
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Enumeration Date | 07/03/2008
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Last Update Date | 07/03/2008
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Provider Practice Location Address
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Address Line | 8477A COUNTY ROAD 64 SUITE 3
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City | DAPHNE
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State | AL
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Zip | 36526-8714
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Country | US
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Telephone | 251-621-1301
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Fax |
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Provider Business Mailing Address
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Address Line | 8477A COUNTY ROAD 64 SUITE 3
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City | DAPHNE
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State | AL
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Zip | 36526-8714
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Country | US
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Telephone | 251-621-1301
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. MICHAEL ALBERT NEBRIG
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Credential | DMD
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Telephone | 251-621-1301
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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 | 5509
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License Number State | AL
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