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General NPI Number Information
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NPI Number | 1528443546
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Entity Type | Organization
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Legal Business Name | PIEDMONT DENTAL GROUP LLC
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Dates
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Enumeration Date | 07/21/2015
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Last Update Date | 08/10/2015
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Provider Practice Location Address
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Address Line | 114 W LADIGA ST
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City | PIEDMONT
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State | AL
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Zip | 36272-2018
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Country | US
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Telephone | 256-447-7844
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Fax |
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Provider Business Mailing Address
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Address Line | 114 W LADIGA ST
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City | PIEDMONT
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State | AL
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Zip | 36272-2018
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Country | US
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Telephone | 256-447-7844
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. JEFFREY RAY EBERHART
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Credential | D.M.D
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Telephone | 256-927-2600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 5161
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 4860
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License Number State | AL
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 5112
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License Number State | AL
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