Provider Demographics
NPI:1083140305
Name:280 DENTAL CARE LLC
Entity Type:Organization
Organization Name:280 DENTAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:GARRETT
Authorized Official - Last Name:RICE
Authorized Official - Suffix:III
Authorized Official - Credentials:DMD
Authorized Official - Phone:706-207-7133
Mailing Address - Street 1:33044 US HIGHWAY 280
Mailing Address - Street 2:
Mailing Address - City:CHILDERSBURG
Mailing Address - State:AL
Mailing Address - Zip Code:35044-1896
Mailing Address - Country:US
Mailing Address - Phone:706-207-7133
Mailing Address - Fax:
Practice Address - Street 1:33044 US HIGHWAY 280
Practice Address - Street 2:
Practice Address - City:CHILDERSBURG
Practice Address - State:AL
Practice Address - Zip Code:35044-1896
Practice Address - Country:US
Practice Address - Phone:706-207-7133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-05
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5959261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental