Provider Demographics
NPI:1225393465
Name:ALABAMA DENTAL PROFESSIONALS PC
Entity Type:Organization
Organization Name:ALABAMA DENTAL PROFESSIONALS PC
Other - Org Name:LIMESTON SMILES OF ATHENS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CRED SUPEWS
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:ZUBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-5170
Mailing Address - Street 1:220 D FRENCH FARMS BVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35611
Mailing Address - Country:US
Mailing Address - Phone:256-233-4803
Mailing Address - Fax:256-233-4805
Practice Address - Street 1:220 D FRENCH FARMS BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611
Practice Address - Country:US
Practice Address - Phone:256-233-4803
Practice Address - Fax:256-233-4805
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALABAMA DENTAL PROFESONAL PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-07-12
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223G0001X
AL38361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1437242195OtherNPI
AL1942570361OtherNPI