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General NPI Number Information
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NPI Number | 1538775150
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Entity Type | Organization
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Legal Business Name | GRANTS MILL FAMILY DENTISTRY, LLC
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Dates
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Enumeration Date | 09/18/2020
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Last Update Date | 12/11/2020
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Provider Practice Location Address
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Address Line | 1024 GRANTS MILL RD
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City | IRONDALE
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State | AL
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Zip | 35210-2108
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Country | US
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Telephone | 205-857-3600
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Fax | 205-857-3600
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Provider Business Mailing Address
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Address Line | 1024 GRANTS MILL RD
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City | IRONDALE
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State | AL
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Zip | 35210-2108
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Country | US
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Telephone | 205-857-3600
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Fax | 205-857-3600
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANDREA HOLMES WILEY
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Credential | DMD
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Telephone | 334-354-1384
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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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