Provider Demographics
NPI:1164844718
Name:ROCKET CITY KIDS PEDIATRIC DENTISTRY, LLC
Entity Type:Organization
Organization Name:ROCKET CITY KIDS PEDIATRIC DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WHITNEY
Authorized Official - Middle Name:O
Authorized Official - Last Name:SHELTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:256-882-2466
Mailing Address - Street 1:1105 GLENEAGLES DR SW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-6405
Mailing Address - Country:US
Mailing Address - Phone:256-882-2466
Mailing Address - Fax:256-882-2402
Practice Address - Street 1:1105 GLENEAGLES DR SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-6405
Practice Address - Country:US
Practice Address - Phone:256-882-2466
Practice Address - Fax:256-882-2402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-16
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4127261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental