Provider Demographics
NPI:1003162389
Name:REDMOND DENTAL, INC.
Entity Type:Organization
Organization Name:REDMOND DENTAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:REDMOND
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-640-0145
Mailing Address - Street 1:2301 MOODY PKWY
Mailing Address - Street 2:STE #9
Mailing Address - City:MOODY
Mailing Address - State:AL
Mailing Address - Zip Code:35004-3012
Mailing Address - Country:US
Mailing Address - Phone:205-640-0145
Mailing Address - Fax:205-640-6002
Practice Address - Street 1:2301 MOODY PKWY
Practice Address - Street 2:STE #9
Practice Address - City:MOODY
Practice Address - State:AL
Practice Address - Zip Code:35004-3012
Practice Address - Country:US
Practice Address - Phone:205-640-0145
Practice Address - Fax:205-640-6002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL52131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty