Provider Demographics
NPI:1114266558
Name:GENERAL DENTISTRY AND SAME DAY DENTURE CLINIC,LLC
Entity Type:Organization
Organization Name:GENERAL DENTISTRY AND SAME DAY DENTURE CLINIC,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:C
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:256-845-3050
Mailing Address - Street 1:1201 BRIARWOOD AVE SW
Mailing Address - Street 2:
Mailing Address - City:FORT PAYNE
Mailing Address - State:AL
Mailing Address - Zip Code:35967-8473
Mailing Address - Country:US
Mailing Address - Phone:256-845-3050
Mailing Address - Fax:256-845-3057
Practice Address - Street 1:940 GILBERT FERRY RD SE
Practice Address - Street 2:B
Practice Address - City:ATTALLA
Practice Address - State:AL
Practice Address - Zip Code:35954-3338
Practice Address - Country:US
Practice Address - Phone:256-845-3050
Practice Address - Fax:256-845-3057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-05
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5489122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty