MEDICARE: GREAT EXPRESSIONS DENTAL CARE

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
1	1223G0001X	General Practice Dentistry	5312	AL

General Provider Information

NPI Number	:	1801934815
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREAT EXPRESSIONS DENTAL CARE

Provider Business Mailing Address
First Line	:	PO BOX 1777
Second Line	:
City	:	NORMAL
State	:	AL
Zip	:	35762-1777
Country	:	US
Telephone Number	:	256-859-0902
Fax Number	:	256-859-0012

Provider Business Practice Location Address
First Line	:	5045 NORTH MEMORIAL PARKWAY
Second Line	:	STE D
City	:	HUNSTVILLE
State	:	AL
Zip	:	35810
Country	:	US
Telephone Number	:	256-859-0902
Fax Number	:	256-859-0012

Authorized Official
Title or Position	:	OWNER DENTIST
Name	:	DR. TRACIE M BATTLE
Credential	:	DMD
Telephone Number	:	256-859-0902

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	08/22/2020

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