MEDICARE: AL DENTAL PROFESSIONALS II PC

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	122300000X	Dentist

General Provider Information

NPI Number	:	1821537788
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AL DENTAL PROFESSIONALS II PC

Provider Business Mailing Address
First Line	:	2505 21ST AVE S
Second Line	:	SUITE#204,
City	:	NASHVILLE
State	:	TN
Zip	:	37212-5652
Country	:	US
Telephone Number	:	615-620-5990
Fax Number	:	888-702-3012

Provider Business Practice Location Address
First Line	:	1518 N BRINDLEE MOUNTAIN PKWY
Second Line	:
City	:	ARAB
State	:	AL
Zip	:	35016-5723
Country	:	US
Telephone Number	:	256-586-3117
Fax Number	:	256-586-3452

Authorized Official
Title or Position	:	OWNER
Name	:	JONATHAN B DENTON
Credential	:	DMD
Telephone Number	:	256-586-3117

Provider Enumeration Date	:	02/13/2017
Last Update Date	:	02/13/2017

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