Provider Demographics
NPI:1316580046
Name:AL DOTHAN DENTAL PROFESSIONALS PC
Entity Type:Organization
Organization Name:AL DOTHAN DENTAL PROFESSIONALS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, REVENUE CYCLE OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HARP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-372-7358
Mailing Address - Street 1:2505 21ST AVE S STE 204
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-5652
Mailing Address - Country:US
Mailing Address - Phone:678-372-7358
Mailing Address - Fax:
Practice Address - Street 1:100 METRO DR
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-1985
Practice Address - Country:US
Practice Address - Phone:334-699-5555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-25
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty