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General NPI Number Information
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NPI Number | 1609599349
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Entity Type | Organization
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Legal Business Name | SOUTHERN COMFORT DENTAL ANESTHESIA
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Dates
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Enumeration Date | 09/19/2022
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Last Update Date | 09/26/2022
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Provider Practice Location Address
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Address Line | 4032 BALMORAL DR SW
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City | HUNTSVILLE
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State | AL
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Zip | 35801-6402
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Country | US
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Telephone | 720-936-9168
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Fax |
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Provider Business Mailing Address
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Address Line | 108 MEADOWGLADE LN
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City | MADISON
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State | AL
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Zip | 35758-6851
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Country | US
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Telephone | 720-936-9168
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PAUL WILSON
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Credential | DMD
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Telephone | 720-936-9168
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0004X
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Taxonomy Name | Dental Anesthesiology
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License Number |
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License Number State |
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