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General NPI Number Information
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NPI Number | 1629549811
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Entity Type | Organization
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Legal Business Name | NEW BEGINNINGS DENTAL LLC
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Dates
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Enumeration Date | 12/16/2018
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Last Update Date | 05/20/2019
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Provider Practice Location Address
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Address Line | 2481 PINNACLE WAY
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City | PRATTVILLE
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State | AL
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Zip | 36066-6543
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Country | US
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Telephone | 630-779-7400
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Fax |
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Provider Business Mailing Address
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Address Line | 2481 PINNACLE WAY
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City | PRATTVILLE
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State | AL
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Zip | 36066-6543
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Country | US
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Telephone | 630-779-7400
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MISS GABRIELLA GRACE BIANCALANA
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Credential |
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Telephone | 205-217-1238
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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 |
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License Number State |
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