Provider Demographics
NPI:1477199511
Name:KENTROS DENTAL LLC
Entity Type:Organization
Organization Name:KENTROS DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:TAMIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-937-0746
Mailing Address - Street 1:PELHAMDENTALCARE@OUTLOOK.COM
Mailing Address - Street 2:1973 CHANDALAR DRIVE
Mailing Address - City:PELHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35124
Mailing Address - Country:US
Mailing Address - Phone:205-663-6246
Mailing Address - Fax:205-663-0242
Practice Address - Street 1:PELHAMDENTALCARE@OUTLOOK.COM
Practice Address - Street 2:1973 CHANDALAR DRIVE
Practice Address - City:PELHAM
Practice Address - State:AL
Practice Address - Zip Code:35124
Practice Address - Country:US
Practice Address - Phone:205-663-6246
Practice Address - Fax:205-663-0242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental