Provider Demographics
NPI:1003035080
Name:TATUM & TATUM
Entity Type:Organization
Organization Name:TATUM & TATUM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAWFORD
Authorized Official - Middle Name:A
Authorized Official - Last Name:TATUM
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:334-745-6393
Mailing Address - Street 1:614 AVENUE A
Mailing Address - Street 2:P.O. BOX 2326
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-5062
Mailing Address - Country:US
Mailing Address - Phone:334-745-6393
Mailing Address - Fax:334-749-5290
Practice Address - Street 1:614 AVENUE A
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-5062
Practice Address - Country:US
Practice Address - Phone:334-745-6393
Practice Address - Fax:334-749-5290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3200122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty