Provider Demographics
NPI:1336456771
Name:DEREK J DOSS DMD LLC
Entity Type:Organization
Organization Name:DEREK J DOSS DMD LLC
Other - Org Name:DOSS DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:DOSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-238-1345
Mailing Address - Street 1:56 CALERA MARKET PLACE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:CALERA
Mailing Address - State:AL
Mailing Address - Zip Code:35040
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:90 MARKETPLACE CIR
Practice Address - Street 2:SUITE A
Practice Address - City:CALERA
Practice Address - State:AL
Practice Address - Zip Code:35040-8200
Practice Address - Country:US
Practice Address - Phone:205-238-1345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5765302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization