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General NPI Number Information
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NPI Number | 1528581170
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Entity Type | Organization
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Legal Business Name | MIDTOWN FAMILY DENTAL, P.C.
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Dates
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Enumeration Date | 07/25/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 79 MIDTOWN PARK E
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City | MOBILE
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State | AL
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Zip | 36606-4141
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Country | US
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Telephone | 251-473-3571
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Fax | 251-473-3581
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Provider Business Mailing Address
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Address Line | 79 MIDTOWN PARK E
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City | MOBILE
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State | AL
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Zip | 36606-4141
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Country | US
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Telephone | 251-473-3571
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Fax | 251-473-3581
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAMES BLACKMAN
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Credential | DMD
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Telephone | 251-473-3571
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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 | 3655
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License Number State | AL
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