1730459538 NPI number — DR. TREY'S CHILDREN'S DENTISTRY

Table of content: (NPI 1730459538)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730459538 NPI number — DR. TREY'S CHILDREN'S DENTISTRY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. TREY'S CHILDREN'S DENTISTRY
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:
1730459538
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/02/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
303 N SECTION ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRHOPE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36532-2634
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-928-3030
Provider Business Mailing Address Fax Number:
251-928-2455

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24208 US HIGHWAY 98
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
FAIRHOPE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36532-3466
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-928-3030
Provider Business Practice Location Address Fax Number:
251-928-2455
Provider Enumeration Date:
01/10/2012

Additional Information

Authorized Official

Authorized Official Last Name:
FELLERS
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
HOKE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
251-928-3030

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X , with the licence number:  5292 , 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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