Provider Demographics
NPI:1083917850
Name:COMPLETE DENTAL CENTER ATHENS
Entity Type:Organization
Organization Name:COMPLETE DENTAL CENTER ATHENS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:W
Authorized Official - Last Name:SELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:06271997
Authorized Official - Phone:256-774-7228
Mailing Address - Street 1:120 W DUBLIN DR STE 202
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-3157
Mailing Address - Country:US
Mailing Address - Phone:256-774-7228
Mailing Address - Fax:256-774-2777
Practice Address - Street 1:607 E HOBBS ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611-2150
Practice Address - Country:US
Practice Address - Phone:256-774-7228
Practice Address - Fax:256-464-5763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-16
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL48771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty