Provider Demographics
NPI:1205007457
Name:MOUNTAIN VIEW FAMILY DENTISTRY INC
Entity Type:Organization
Organization Name:MOUNTAIN VIEW FAMILY DENTISTRY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JO ANN
Authorized Official - Middle Name:TUBBS
Authorized Official - Last Name:CRIM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:256-533-2746
Mailing Address - Street 1:110 WOODSIDE DR SE
Mailing Address - Street 2:
Mailing Address - City:OWENS CROSS ROADS
Mailing Address - State:AL
Mailing Address - Zip Code:35763-9787
Mailing Address - Country:US
Mailing Address - Phone:256-533-2746
Mailing Address - Fax:256-533-2747
Practice Address - Street 1:110 WOODSIDE DR SE
Practice Address - Street 2:
Practice Address - City:OWENS CROSS ROADS
Practice Address - State:AL
Practice Address - Zip Code:35763-9787
Practice Address - Country:US
Practice Address - Phone:256-533-2746
Practice Address - Fax:256-533-2747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL53521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty