Provider Demographics
NPI:1417179904
Name:COMPREHENSIVE DENTISTRY OF ORANGE BEACH
Entity Type:Organization
Organization Name:COMPREHENSIVE DENTISTRY OF ORANGE BEACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:DEXTER
Authorized Official - Last Name:DUNAVANT
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:251-974-1512
Mailing Address - Street 1:2750 ROLLINS RD
Mailing Address - Street 2:
Mailing Address - City:ORANGE BEACH
Mailing Address - State:AL
Mailing Address - Zip Code:36561-3059
Mailing Address - Country:US
Mailing Address - Phone:251-974-1512
Mailing Address - Fax:251-974-1468
Practice Address - Street 1:2750 ROLLINS RD
Practice Address - Street 2:
Practice Address - City:ORANGE BEACH
Practice Address - State:AL
Practice Address - Zip Code:36561-3059
Practice Address - Country:US
Practice Address - Phone:251-974-1512
Practice Address - Fax:251-974-1468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4155261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental