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General NPI Number Information
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NPI Number | 1952825523
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Entity Type | Organization
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Legal Business Name | SAND MOUNTAIN DENTISTRY, LLC
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Dates
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Enumeration Date | 07/26/2017
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Last Update Date | 07/26/2017
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Provider Practice Location Address
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Address Line | 416 MARTLING ROAD
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City | ALBERTVILLE
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State | AL
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Zip | 35951
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Country | US
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Telephone | 256-891-1100
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Fax | 256-891-1160
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Provider Business Mailing Address
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Address Line | P O BOX 889
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City | ALBERTVILLE
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State | AL
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Zip | 35950
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Country | US
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Telephone | 256-891-1100
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Fax | 256-891-1160
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | THOMAS ALLEN KIRBY
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Credential | DDS
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Telephone | 256-891-1100
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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 | 4797
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License Number State | AL
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