Provider Demographics
NPI:1164526281
Name:TITTLE, RODNEY ALLEN (DMD)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:ALLEN
Last Name:TITTLE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:RODNEY
Other - Middle Name:
Other - Last Name:TITTLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:895 BANKHEAD HWY
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35594
Mailing Address - Country:US
Mailing Address - Phone:205-487-5004
Mailing Address - Fax:205-487-4376
Practice Address - Street 1:895 BANKHEAD HWY
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:AL
Practice Address - Zip Code:35594
Practice Address - Country:US
Practice Address - Phone:205-487-5004
Practice Address - Fax:205-487-4376
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL46731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
45972OtherBCBS