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General NPI Number Information
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NPI Number | 1841374899
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Entity Type | Organization
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Legal Business Name | DAPHNE PEDIATRIC DENTISTRY INC
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7058 PROFESSIONAL PLACE
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City | DAPHNE
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State | AL
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Zip | 36526
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Country | US
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Telephone | 251-447-0627
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Fax | 251-447-0639
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Provider Business Mailing Address
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Address Line | 7058 PROFESSIONAL PLACE
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City | DAPHNE
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State | AL
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Zip | 36526
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Country | US
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Telephone | 251-447-0627
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Fax | 251-447-0639
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Authorized Official
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Title or Position | PEDIATRIC DENTIST
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Name | HAROLD TODD CHAMBLISS
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Credential | DMD
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Telephone | 251-447-0627
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 4830
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License Number State | AL
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