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General NPI Number Information
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NPI Number | 1750486684
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Entity Type | Organization
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Legal Business Name | BRENT DENTAL CARE
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 09/12/2007
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Provider Practice Location Address
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Address Line | 2939 MAIN ST BOX 960
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City | BRENT
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State | AL
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Zip | 35034-4000
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Country | US
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Telephone | 205-926-1901
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Fax |
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Provider Business Mailing Address
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Address Line | 2939 MAIN ST P.O. BOX 960
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City | BRENT
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State | AL
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Zip | 35034-4000
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Country | US
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Telephone | 205-926-1901
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. DAYO OBEBE
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Credential | DMD
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Telephone | 205-936-2151
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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 | AL 4726
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License Number State | AL
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