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General NPI Number Information
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NPI Number | 1861295362
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Entity Type | Organization
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Legal Business Name | NORTHPORT PERIODONTICS AND IMPLANT DENTISTRY LLC
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Dates
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Enumeration Date | 03/31/2025
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Last Update Date | 03/31/2025
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Provider Practice Location Address
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Address Line | 920 ROSE DR
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City | NORTHPORT
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State | AL
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Zip | 35476-3363
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Country | US
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Telephone | 205-737-4667
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Fax |
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Provider Business Mailing Address
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Address Line | 2687 SWISS LN
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City | HOOVER
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State | AL
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Zip | 35226-2361
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KENNETH LIU
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Credential | DMD, MS
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Telephone | 205-737-4667
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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