=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497933253
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EAST ALABAMA PEDIATRIC DENTISTRY & ORTHODONTICS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/04/2008
-----------------------------------------------------
Last Update Date | 02/04/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 742 N DEAN RD
-----------------------------------------------------
City | AUBURN
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36830-4300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-321-0780
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 742 N DEAN RD
-----------------------------------------------------
City | AUBURN
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36830-4300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-321-0780
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | SANDRA J BUFF
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 334-321-0780
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number | 1223PO221X
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number | 5221
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------