Provider Demographics
NPI:1437582285
Name:ALABAMA FAMILY DENTISTRY LLC
Entity Type:Organization
Organization Name:ALABAMA FAMILY DENTISTRY LLC
Other - Org Name:SUMITON FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-648-6054
Mailing Address - Street 1:205 CALDWELL DR
Mailing Address - Street 2:
Mailing Address - City:WARRIOR
Mailing Address - State:AL
Mailing Address - Zip Code:35180-1407
Mailing Address - Country:US
Mailing Address - Phone:205-647-3181
Mailing Address - Fax:
Practice Address - Street 1:385 BRYAN RD STE 300
Practice Address - Street 2:
Practice Address - City:SUMITON
Practice Address - State:AL
Practice Address - Zip Code:35148-3440
Practice Address - Country:US
Practice Address - Phone:205-648-6054
Practice Address - Fax:205-648-3625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-15
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL54761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty