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General NPI Number Information
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NPI Number | 1982002150
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Entity Type | Organization
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Legal Business Name | AULTMAN DENTAL
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Dates
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Enumeration Date | 12/19/2014
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Last Update Date | 12/19/2014
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Provider Practice Location Address
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Address Line | 2043 MARTIN ST S
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City | PELL CITY
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State | AL
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Zip | 35128-2329
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Country | US
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Telephone | 205-812-2005
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Fax | 205-812-2007
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Provider Business Mailing Address
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Address Line | 2043 MARTIN ST S
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City | PELL CITY
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State | AL
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Zip | 35128-2329
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Country | US
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Telephone | 205-812-2005
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Fax | 205-812-2007
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | JAMES ALAN AULTMAN
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Credential | DMD, MS
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Telephone | 205-812-2005
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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 | 6085
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License Number State | AL
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