Provider Demographics
NPI:1407279722
Name:DENTAL PROFESSIONALS ON WHITESBURG
Entity Type:Organization
Organization Name:DENTAL PROFESSIONALS ON WHITESBURG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:LAMBERT
Authorized Official - Last Name:WINTZELL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:256-883-6770
Mailing Address - Street 1:8315 WHITESBURG DR SE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-3007
Mailing Address - Country:US
Mailing Address - Phone:256-883-6770
Mailing Address - Fax:256-883-8355
Practice Address - Street 1:8315 WHITESBURG DR SE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-3007
Practice Address - Country:US
Practice Address - Phone:256-883-6770
Practice Address - Fax:256-883-8355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-22
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5030261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental