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General NPI Number Information
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NPI Number | 1912633900
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Entity Type | Organization
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Legal Business Name | AUBURN IMPLANT DENTISTRY, LLC
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Dates
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Enumeration Date | 08/01/2022
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Last Update Date | 08/02/2022
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Provider Practice Location Address
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Address Line | 670 N COLLEGE ST STE D
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City | AUBURN
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State | AL
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Zip | 36830-3030
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Country | US
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Telephone | 334-209-1352
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Fax |
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Provider Business Mailing Address
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Address Line | 670 N COLLEGE ST STE D
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City | AUBURN
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State | AL
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Zip | 36830-3030
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Country | US
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Telephone | 334-209-1352
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Fax |
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Authorized Official
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Title or Position | PERIODONTIST/OWNER
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Name | DR. BRITANY FABIAN MATIN
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Credential | DMD, MS
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Telephone | 334-209-1352
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number |
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License Number State |
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Taxonomy #2
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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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