Provider Demographics
NPI:1437769502
Name:SRUPTON, LLC
Entity Type:Organization
Organization Name:SRUPTON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:UPTON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-821-1976
Mailing Address - Street 1:3920 BUTLER SPRINGS WAY
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35226-6234
Mailing Address - Country:US
Mailing Address - Phone:205-249-7354
Mailing Address - Fax:
Practice Address - Street 1:1810 DECATUR HWY STE 212
Practice Address - Street 2:
Practice Address - City:FULTONDALE
Practice Address - State:AL
Practice Address - Zip Code:35068-1700
Practice Address - Country:US
Practice Address - Phone:205-874-9605
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty