MEDICARE: SBBW INC

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	6071 C1	AL

General Provider Information

NPI Number	:	1831636885
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SBBW INC

Provider Business Mailing Address
First Line	:	25299 CANAL RD
Second Line	:	SUITE A5
City	:	ORANGE BEACH
State	:	AL
Zip	:	36561-5814
Country	:	US
Telephone Number	:	251-321-7575
Fax Number	:

Provider Business Practice Location Address
First Line	:	25299 CANAL RD
Second Line	:	SUITE A5
City	:	ORANGE BEACH
State	:	AL
Zip	:	36561-5814
Country	:	US
Telephone Number	:	251-321-7575
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. LAUREN HOLLOWAY LEE
Credential	:	DMD
Telephone Number	:	334-714-5257

Provider Enumeration Date	:	01/30/2017
Last Update Date	:	01/30/2017

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