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General NPI Number Information
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NPI Number | 1659966067
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Entity Type | Organization
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Legal Business Name | SINGING RIVER DENTISTRY EAST, LLC
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Dates
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Enumeration Date | 03/08/2021
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Last Update Date | 03/08/2021
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Provider Practice Location Address
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Address Line | 100 PROVIDENCE MAIN ST NW SUITE C
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City | HUNTSVILLE
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State | AL
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Zip | 35806-4827
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Country | US
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Telephone | 256-653-9830
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Fax | 256-469-7905
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Provider Business Mailing Address
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Address Line | 110 E 5TH ST
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City | TUSCUMBIA
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State | AL
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Zip | 35674-2410
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Country | US
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Telephone | 256-383-8037
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Fax | 256-320-5274
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Authorized Official
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Title or Position | OWNER
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Name | JAMES THOMAS GARDINER
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Credential | DMD
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Telephone | 256-383-0377
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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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