Provider Demographics
NPI:1235581695
Name:BRAD C LITKENHOUS, PC
Entity Type:Organization
Organization Name:BRAD C LITKENHOUS, PC
Other - Org Name:AUBURN DENTAL SPA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:CHANEY
Authorized Official - Last Name:LITKENHOUS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:334-821-2846
Mailing Address - Street 1:1575 PROFESSIONAL PKWY
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-2858
Mailing Address - Country:US
Mailing Address - Phone:334-821-2846
Mailing Address - Fax:334-821-4322
Practice Address - Street 1:1575 PROFESSIONAL PKWY
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-2858
Practice Address - Country:US
Practice Address - Phone:334-821-2846
Practice Address - Fax:334-821-4322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL53401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty