Provider Demographics
NPI:1083069579
Name:SCOTTSBORO FAMILY AND GENERAL DENTISTRY PC
Entity Type:Organization
Organization Name:SCOTTSBORO FAMILY AND GENERAL DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRETT
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRADFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:256-259-4411
Mailing Address - Street 1:420 S MARKET ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35768-1857
Mailing Address - Country:US
Mailing Address - Phone:256-259-4411
Mailing Address - Fax:256-574-5653
Practice Address - Street 1:420 S MARKET ST
Practice Address - Street 2:
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35768-1857
Practice Address - Country:US
Practice Address - Phone:256-259-4411
Practice Address - Fax:256-574-5653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-03
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALD6098261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental