Provider Demographics
NPI:1184647596
Name:ALBRITTON, DWAYNE B (DMD)
Entity Type:Individual
Prefix:DR
First Name:DWAYNE
Middle Name:B
Last Name:ALBRITTON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 660845
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35266-0845
Mailing Address - Country:US
Mailing Address - Phone:205-879-9761
Mailing Address - Fax:205-879-6565
Practice Address - Street 1:536 COBB ST
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-6511
Practice Address - Country:US
Practice Address - Phone:205-879-9761
Practice Address - Fax:205-879-6565
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL43481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529802060Medicaid