Provider Demographics
NPI:1013218486
Name:DENTAL ASSOCIATES OF ROGERSVILLE, LLC
Entity Type:Organization
Organization Name:DENTAL ASSOCIATES OF ROGERSVILLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:256-355-2275
Mailing Address - Street 1:16090 HIGHWAY 72
Mailing Address - Street 2:
Mailing Address - City:ROGERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35652-8111
Mailing Address - Country:US
Mailing Address - Phone:256-247-1000
Mailing Address - Fax:256-247-1007
Practice Address - Street 1:16090 HIGHWAY 72
Practice Address - Street 2:
Practice Address - City:ROGERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35652-8111
Practice Address - Country:US
Practice Address - Phone:256-247-1000
Practice Address - Fax:256-247-1007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-16
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty