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General NPI Number Information
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NPI Number | 1619207719
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Entity Type | Organization
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Legal Business Name | COMPLETE DENTAL CENTER HUNTSVILLE
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Dates
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Enumeration Date | 01/12/2010
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Last Update Date | 01/12/2010
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Provider Practice Location Address
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Address Line | 7540 MEMORIAL PKWY SW SUITE R
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City | HUNTSVILLE
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State | AL
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Zip | 35802-2265
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Country | US
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Telephone | 256-258-0777
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Fax |
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Provider Business Mailing Address
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Address Line | 120 W DUBLIN DR SUITE 202
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City | MADISON
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State | AL
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Zip | 35758-3155
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Country | US
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Telephone | 256-774-7228
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Fax | 256-774-2777
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. SHELLY M JOHNSON
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Credential |
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Telephone | 256-774-7228
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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 | 5290
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License Number State | AL
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