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General NPI Number Information
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NPI Number | 1558468108
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Entity Type | Organization
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Legal Business Name | MRM, LLC
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Dates
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Enumeration Date | 09/17/2006
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Last Update Date | 01/25/2010
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Provider Practice Location Address
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Address Line | 1402 VETERANS MEMORIAL PKWY SUITE B
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City | TUSCALOOSA
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State | AL
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Zip | 35404-4790
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Country | US
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Telephone | 205-556-6511
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Fax | 205-556-6571
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Provider Business Mailing Address
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Address Line | 1402 VETERANS MEMORIAL PKWY SUITE B
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City | TUSCALOOSA
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State | AL
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Zip | 35404-4790
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Country | US
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Telephone | 205-556-6511
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Fax | 205-556-6571
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Authorized Official
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Title or Position | DENTIST/MANAGER
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Name | DR. MATTHEW RYAN MCCRACKEN
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Credential | D.M.D.
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Telephone | 205-556-6511
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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 |
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License Number State |
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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 |
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License Number State |
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