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General NPI Number Information
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NPI Number | 1790367126
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Entity Type | Organization
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Legal Business Name | SAND MOUNTAIN FAMILY DENTISTRY LLC
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Dates
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Enumeration Date | 04/26/2021
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Last Update Date | 05/19/2021
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Provider Practice Location Address
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Address Line | 701 MEDICAL CENTER PKWY
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City | BOAZ
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State | AL
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Zip | 35957-5938
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Country | US
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Telephone | 205-467-0387
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Fax |
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Provider Business Mailing Address
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Address Line | 211 DOGWOOD CIR
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City | GADSDEN
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State | AL
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Zip | 35901-5601
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Country | US
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Telephone | 205-467-0387
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. BRANT HAYNIE
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Credential | DMD
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Telephone | 205-467-0387
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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 |
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License Number State |
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