Provider Demographics
NPI:1477067783
Name:FAIRHOPE COSMETIC AND FAMILY DENTISTRY, PC
Entity Type:Organization
Organization Name:FAIRHOPE COSMETIC AND FAMILY DENTISTRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:THEODORE
Authorized Official - Last Name:MELTON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:251-990-7797
Mailing Address - Street 1:101 FLY CREEK AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-8310
Mailing Address - Country:US
Mailing Address - Phone:251-990-7797
Mailing Address - Fax:
Practice Address - Street 1:101 FLY CREEK AVE STE 301
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-8310
Practice Address - Country:US
Practice Address - Phone:251-990-7797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-22
Last Update Date:2017-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3784261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental