Provider Demographics
NPI:1073917399
Name:FERRELL FAMILY DENTAL, P.C.
Entity Type:Organization
Organization Name:FERRELL FAMILY DENTAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:SEAN
Authorized Official - Last Name:FERRELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:251-970-1600
Mailing Address - Street 1:1545 GULF SHORES PKWY
Mailing Address - Street 2:PMB 302
Mailing Address - City:GULF SHORES
Mailing Address - State:AL
Mailing Address - Zip Code:36542-3435
Mailing Address - Country:US
Mailing Address - Phone:251-970-1600
Mailing Address - Fax:866-316-5030
Practice Address - Street 1:8154 HWY 59
Practice Address - Street 2:SUITE 217
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535
Practice Address - Country:US
Practice Address - Phone:251-970-1600
Practice Address - Fax:866-316-5030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-15
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5861122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty