1245360593 NPI number — DENTAL CARE OF ALABAMA LLC

Table of content: (NPI 1245360593)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245360593 NPI number — DENTAL CARE OF ALABAMA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DENTAL CARE OF ALABAMA LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CUMBERLAND DENTAL OF TUSCALOOSA
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245360593
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1701 MCFARLAND BLVD E
Provider Second Line Business Mailing Address:
SUITE 122 UNIVERSITY MALL
Provider Business Mailing Address City Name:
TUSCALOOSA
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35404-5824
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-556-2980
Provider Business Mailing Address Fax Number:
205-553-8554

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1701 MCFARLAND BLVD E
Provider Second Line Business Practice Location Address:
SUITE 122 UNIVERSITY MALL
Provider Business Practice Location Address City Name:
TUSCALOOSA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35404-5824
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-556-2980
Provider Business Practice Location Address Fax Number:
205-553-8554
Provider Enumeration Date:
03/06/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WHITE
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
205-556-2980

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X , with the licence number:  4341 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)