Provider Demographics
NPI:1225415771
Name:OXFORD PEDIATRIC DENTAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:OXFORD PEDIATRIC DENTAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:BAKER
Authorized Official - Last Name:CHAMBLISS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-338-4227
Mailing Address - Street 1:50 CROPWELL DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PELL CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35128-7552
Mailing Address - Country:US
Mailing Address - Phone:205-338-4227
Mailing Address - Fax:205-338-5558
Practice Address - Street 1:1409 HAMRIC DR E
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:AL
Practice Address - Zip Code:36203-1933
Practice Address - Country:US
Practice Address - Phone:205-338-4227
Practice Address - Fax:205-338-5558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-05
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty