MEDICARE: FLINT RIVER DENTISTRY, LLC

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	261QD0000X	Dental Clinic/Center	5585	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0	OTHER		NONE

General Provider Information

NPI Number	:	1902387426
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLINT RIVER DENTISTRY, LLC

Provider Business Mailing Address
First Line	:	2246 WINCHESTER RD NE STE 106
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35811-6801
Country	:	US
Telephone Number	:	256-859-8066
Fax Number	:

Provider Business Practice Location Address
First Line	:	2246 WINCHESTER RD NE STE 106
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35811-6801
Country	:	US
Telephone Number	:	256-859-8066
Fax Number	:

Authorized Official
Title or Position	:	OWNER DENTIST
Name	:	MEGHAN DARBY
Credential	:	DMD
Telephone Number	:	256-529-3082

Provider Enumeration Date	:	08/23/2018
Last Update Date	:	10/22/2021

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Directions to “FLINT RIVER DENTISTRY, LLC ” Practice Location

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