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NPI Code Detail

MEDICARE: DR. THOMAS BRENT CHURCH D.M.D.

MEDICARE:  DR. THOMAS BRENT CHURCH  D.M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist6294AL

General Provider Information

NPI Number : 1659720415
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. THOMAS BRENT CHURCH D.M.D.
Provider Business Mailing Address
First Line : 1013 9TH TER
Second Line :
City : PLEASANT GROVE
State : AL
Zip : 35127-2209
Country : US
Telephone Number : 205-478-3569
Fax Number :
Provider Business Practice Location Address
First Line : 5528 1ST AVE N
Second Line :
City : BIRMINGHAM
State : AL
Zip : 35212-2445
Country : US
Telephone Number : 205-592-2255
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/11/2016
Last Update Date : 06/11/2016

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Directions to “ DR. THOMAS BRENT CHURCH D.M.D.” Practice Location

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