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General NPI Number Information
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NPI Number | 1922514199
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Entity Type | Organization
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Legal Business Name | DENTAL ASSOCIATES OF HAMPTON COVE LLC
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Dates
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Enumeration Date | 12/23/2017
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Last Update Date | 12/23/2017
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Provider Practice Location Address
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Address Line | 6838 HIGHWAY 431 S STE B
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City | OWENS CROSS ROADS
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State | AL
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Zip | 35763-7201
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Country | US
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Telephone | 256-536-8120
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Fax | 256-536-8154
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Provider Business Mailing Address
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Address Line | 6838B HIGHWAY 431 S STE B
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City | OWENS CROSS ROADS
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State | AL
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Zip | 35763-9224
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Country | US
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Telephone | 256-536-8120
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Fax | 256-536-8154
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Authorized Official
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Title or Position | DENTIST/ PARTNER OWNER
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Name | DR. LORRIE BRACE GREEN
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Credential | DMD
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Telephone | 915-217-8763
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | D6202
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License Number State | AL
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