Provider Demographics
NPI:1093291080
Name:DENTAL ASSOCIATES OF SYLACAUGA LLC
Entity Type:Organization
Organization Name:DENTAL ASSOCIATES OF SYLACAUGA 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:GREGORY
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:256-353-5600
Mailing Address - Street 1:1408 7TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-4216
Mailing Address - Country:US
Mailing Address - Phone:256-353-5600
Mailing Address - Fax:256-351-8006
Practice Address - Street 1:499 W 3RD ST
Practice Address - Street 2:
Practice Address - City:SYLACAUGA
Practice Address - State:AL
Practice Address - Zip Code:35150-1916
Practice Address - Country:US
Practice Address - Phone:256-245-6039
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-13
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL42311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty