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General NPI Number Information
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NPI Number | 1851838833
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Entity Type | Organization
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Legal Business Name | AL DENTAL PROFESSIONALS PC
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Dates
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Enumeration Date | 01/27/2017
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Last Update Date | 01/27/2017
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Provider Practice Location Address
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Address Line | 1518 N BRINDLEE MOUNTAIN PKWY
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City | ARAB
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State | AL
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Zip | 35016-5723
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Country | US
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Telephone | 615-620-5990
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Fax | 888-702-3012
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Provider Business Mailing Address
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Address Line | 2505 21ST AVE S STE 204
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City | NASHVILLE
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State | TN
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Zip | 37212-5652
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Country | US
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Telephone | 615-620-5990
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Fax | 888-702-3012
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Authorized Official
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Title or Position | DENTAL DIRECTOR
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Name | JONATHAN BLAINE DENTON
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Credential | D.M.D.
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Telephone | 615-620-5990
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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 |
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License Number State |
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