Provider Demographics
NPI:1407498819
Name:CALLYN TEDIN DMD PC
Entity Type:Organization
Organization Name:CALLYN TEDIN DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CALLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:TEDIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:334-685-1325
Mailing Address - Street 1:129 1ST ST N
Mailing Address - Street 2:
Mailing Address - City:ALABASTER
Mailing Address - State:AL
Mailing Address - Zip Code:35007-8757
Mailing Address - Country:US
Mailing Address - Phone:205-663-3612
Mailing Address - Fax:205-663-6446
Practice Address - Street 1:129 1ST ST N
Practice Address - Street 2:
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007-8757
Practice Address - Country:US
Practice Address - Phone:205-663-3612
Practice Address - Fax:205-663-6446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-17
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty