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General NPI Number Information
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NPI Number | 1710241724
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Entity Type | Organization
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Legal Business Name | NORTH ALABAMA PROSTHODONTICS, P.C.
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Dates
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Enumeration Date | 06/25/2012
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Last Update Date | 06/25/2012
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Provider Practice Location Address
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Address Line | 807 REGAL DR SW
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City | HUNTSVILLE
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State | AL
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Zip | 35801-5604
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Country | US
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Telephone | 256-517-8071
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Fax | 256-517-8124
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Provider Business Mailing Address
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Address Line | 807 REGAL DR SW
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City | HUNTSVILLE
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State | AL
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Zip | 35801-5604
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Country | US
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Telephone | 256-517-8071
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Fax | 256-517-8124
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Authorized Official
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Title or Position | PRESIDENT/PROSTHODONTIST
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Name | DR. AMANDA HEUSINGER PELTIER
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Credential | D.M.D.
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Telephone | 256-517-8071
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 5654
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License Number State | AL
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