Provider Demographics
NPI:1467171249
Name:CHILDERSBURG FAMILY DENTAL
Entity Type:Organization
Organization Name:CHILDERSBURG FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROXANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:256-694-1958
Mailing Address - Street 1:3810 10TH AVE S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35222-4206
Mailing Address - Country:US
Mailing Address - Phone:205-500-9062
Mailing Address - Fax:
Practice Address - Street 1:138 9TH AVE SW
Practice Address - Street 2:
Practice Address - City:CHILDERSBURG
Practice Address - State:AL
Practice Address - Zip Code:35044-1642
Practice Address - Country:US
Practice Address - Phone:256-378-3127
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental