Provider Demographics
NPI:1376018200
Name:FAIRHOPE BAY DENTAL LLC
Entity Type:Organization
Organization Name:FAIRHOPE BAY DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:AVERY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:251-928-9930
Mailing Address - Street 1:10939 US HIGHWAY 98
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-5408
Mailing Address - Country:US
Mailing Address - Phone:251-928-9930
Mailing Address - Fax:
Practice Address - Street 1:10939 US HIGHWAY 98
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-5408
Practice Address - Country:US
Practice Address - Phone:251-928-9930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-08
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental