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General NPI Number Information
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NPI Number | 1639552284
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Entity Type | Organization
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Legal Business Name | ALABAMA DENTAL PROFESSIONALS PC
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Dates
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Enumeration Date | 07/01/2015
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Last Update Date | 07/01/2015
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Provider Practice Location Address
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Address Line | 19354 GREENO RD
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City | FAIRHOPE
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State | AL
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Zip | 36532-3834
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Country | US
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Telephone | 251-990-8885
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Fax | 251-990-5701
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Provider Business Mailing Address
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Address Line | 19354 GREENO RD
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City | FAIRHOPE
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State | AL
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Zip | 36532-3834
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Country | US
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Telephone | 251-990-8885
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Fax | 251-990-5701
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | JASMINE REARDON
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Credential |
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Telephone | 217-540-8330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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