Provider Demographics
NPI:1447619689
Name:COMPLETE DENTAL NORTH MADISON LLC
Entity Type:Organization
Organization Name:COMPLETE DENTAL NORTH MADISON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HAAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-258-3883
Mailing Address - Street 1:8141 US 72
Mailing Address - Street 2:SUITE. G
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758
Mailing Address - Country:US
Mailing Address - Phone:256-774-7228
Mailing Address - Fax:256-464-5763
Practice Address - Street 1:120 W DUBLIN DR
Practice Address - Street 2:SUITE. 202
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-3155
Practice Address - Country:US
Practice Address - Phone:256-258-3883
Practice Address - Fax:256-464-5763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-16
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL53111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty