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General NPI Number Information
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NPI Number | 1558879817
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Entity Type | Organization
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Legal Business Name | TUSCALOOSA FAMILY DENTAL, LLC
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Dates
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Enumeration Date | 01/19/2018
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Last Update Date | 01/19/2018
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Provider Practice Location Address
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Address Line | 7402 HIGHWAY 69 S
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City | TUSCALOOSA
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State | AL
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Zip | 35405-1300
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Country | US
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Telephone | 205-451-3010
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Fax |
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Provider Business Mailing Address
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Address Line | 1304 TREE CROSSINGS PKWY
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City | HOOVER
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State | AL
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Zip | 35244-4051
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Country | US
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Telephone | 205-451-3010
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KIMBERLY PARKER LEWIS
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Credential | DDS
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Telephone | 205-451-3010
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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 | 6039
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License Number State | AL
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