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General NPI Number Information
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NPI Number | 1588843635
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Entity Type | Organization
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Legal Business Name | TUSCALOOSA PEDIATRIC DENTISTRY, P.C.
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Dates
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Enumeration Date | 10/25/2007
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Last Update Date | 10/25/2007
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Provider Practice Location Address
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Address Line | 2415 VETERANS MEMORIAL PKWY
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City | TUSCALOOSA
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State | AL
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Zip | 35404-4137
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Country | US
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Telephone | 205-556-6100
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Fax | 205-556-6755
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Provider Business Mailing Address
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Address Line | 2415 VETERANS MEMORIAL PKWY
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City | TUSCALOOSA
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State | AL
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Zip | 35404-4137
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Country | US
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Telephone | 205-556-6100
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Fax | 205-556-6755
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WILLIAM WESLEY HOLLOWELL
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Credential | D.M.D.
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Telephone | 205-556-6100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 5447
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License Number State | AL
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