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General NPI Number Information
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NPI Number | 1841785052
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Entity Type | Organization
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Legal Business Name | VANDERVOORT FAMILY DENTISTRY, PC
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Dates
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Enumeration Date | 06/29/2018
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Last Update Date | 01/02/2020
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Provider Practice Location Address
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Address Line | 217 MCFARLAND CIR N
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City | TUSCALOOSA
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State | AL
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Zip | 35406-1800
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Country | US
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Telephone | 205-345-7755
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Fax | 205-343-9075
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Provider Business Mailing Address
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Address Line | 217 MCFARLAND CIR N
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City | TUSCALOOSA
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State | AL
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Zip | 35406-1800
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Country | US
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Telephone | 205-345-7755
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Fax | 205-343-9075
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Authorized Official
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Title or Position | OWNER
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Name | DR. WILLIAM MAURY VANDERVOORT
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Credential | DMD
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Telephone | 205-345-7755
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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 | 6103
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License Number State | AL
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