Provider Demographics
NPI:1437341203
Name:J BRETT BETTIS DMD,PC
Entity Type:Organization
Organization Name:J BRETT BETTIS DMD,PC
Other - Org Name:ARGO FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:BRETT
Authorized Official - Last Name:BETTIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD PC
Authorized Official - Phone:205-467-2211
Mailing Address - Street 1:750 HWY 11
Mailing Address - Street 2:SUITE 4
Mailing Address - City:TRUSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35173-4392
Mailing Address - Country:US
Mailing Address - Phone:205-467-2211
Mailing Address - Fax:205-467-9744
Practice Address - Street 1:750 HWY 11
Practice Address - Street 2:SUITE 4
Practice Address - City:TRUSSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35173-4392
Practice Address - Country:US
Practice Address - Phone:205-467-2211
Practice Address - Fax:205-467-9744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-15
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5069122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
103389OtherUNITED HEALTHCARE
AL51097655OtherBCBS ALA
AL529932885Medicaid
64315OtherUNITED CONCORDIA