Provider Demographics
NPI:1417554072
Name:DR. MATT DELLINGER, DMD,LLC
Entity Type:Organization
Organization Name:DR. MATT DELLINGER, DMD,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRISCOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-734-2778
Mailing Address - Street 1:210 MAIN AVE NW
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35055-2896
Mailing Address - Country:US
Mailing Address - Phone:256-734-2778
Mailing Address - Fax:
Practice Address - Street 1:210 MAIN AVE NW
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-2896
Practice Address - Country:US
Practice Address - Phone:256-734-2778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-07
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental