Provider Demographics
NPI:1306406350
Name:FLORENCE FAMILY DENTAL
Entity Type:Organization
Organization Name:FLORENCE FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:FAWCETT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:256-766-8800
Mailing Address - Street 1:2138 HELTON DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-1449
Mailing Address - Country:US
Mailing Address - Phone:256-766-8800
Mailing Address - Fax:256-760-1063
Practice Address - Street 1:2138 HELTON DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-1449
Practice Address - Country:US
Practice Address - Phone:256-766-8800
Practice Address - Fax:256-760-1063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-20
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental