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General NPI Number Information
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NPI Number | 1598881716
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Entity Type | Organization
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Legal Business Name | PEDIATRIC DENTISTRY ASSOCIATES, PC
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 121 N 20TH ST SUITE 20-C
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City | OPELIKA
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State | AL
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Zip | 36801-5449
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Country | US
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Telephone | 334-745-6443
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Fax | 334-745-3444
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Provider Business Mailing Address
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Address Line | 121 N 20TH ST SUITE 20-C
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City | OPELIKA
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State | AL
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Zip | 36801-5449
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Country | US
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Telephone | 334-745-6443
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Fax | 334-745-3444
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Authorized Official
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Title or Position | CORPORATE SECRETARY
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Name | MRS. ELIZABETH K CARROLL
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Credential |
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Telephone | 334-745-6443
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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 | 3156
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License Number State | AL
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