Provider Demographics
NPI:1336635895
Name:FLORALA FAMILY DENTAL CARE
Entity Type:Organization
Organization Name:FLORALA FAMILY DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:FRERICH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:334-219-5831
Mailing Address - Street 1:24244 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:FLORALA
Mailing Address - State:AL
Mailing Address - Zip Code:36442-3522
Mailing Address - Country:US
Mailing Address - Phone:334-219-5831
Mailing Address - Fax:334-647-6475
Practice Address - Street 1:24244 5TH AVE
Practice Address - Street 2:
Practice Address - City:FLORALA
Practice Address - State:AL
Practice Address - Zip Code:36442-3522
Practice Address - Country:US
Practice Address - Phone:334-219-5831
Practice Address - Fax:334-647-6475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6491C261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental