1619207719 NPI number — COMPLETE DENTAL CENTER HUNTSVILLE

Table of content: DR. PAUL MICHAEL CHRETIEN M.D. (NPI 1972615227)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619207719 NPI number — COMPLETE DENTAL CENTER HUNTSVILLE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPLETE DENTAL CENTER HUNTSVILLE
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:
Provider Other Organization Name Type Code:
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:
1619207719
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/12/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
120 W DUBLIN DR
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
MADISON
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35758-3155
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-774-7228
Provider Business Mailing Address Fax Number:
256-774-2777

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7540 MEMORIAL PKWY SW
Provider Second Line Business Practice Location Address:
SUITE R
Provider Business Practice Location Address City Name:
HUNTSVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35802-2265
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-258-0777
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/12/2010

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
SHELLY
Authorized Official Middle Name:
M
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
256-774-7228

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  5290 , 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)





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