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General NPI Number Information
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NPI Number | 1881020857
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Entity Type | Organization
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Legal Business Name | INDIAN SPRINGS PEDIATRIC DENTISTRY, L.L.C.
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Dates
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Enumeration Date | 09/22/2013
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Last Update Date | 09/22/2013
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Provider Practice Location Address
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Address Line | 6496 QUAIL RUN DR
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City | PELHAM
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State | AL
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Zip | 35124-3104
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Country | US
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Telephone | 205-739-7773
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Fax |
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Provider Business Mailing Address
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Address Line | 6496 QUAIL RUN DR
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City | PELHAM
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State | AL
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Zip | 35124-3104
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Country | US
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Telephone | 205-739-7773
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. ROSALYNN YVETTE CRAWFORD-MCKENDALL
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Credential | D.D.S.
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Telephone | 205-739-7773
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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 |
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License Number State |
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