Provider Demographics
NPI:1487189528
Name:WASHBURN FAMILY DENTAL CARE, INC
Entity Type:Organization
Organization Name:WASHBURN FAMILY DENTAL CARE, INC
Other - Org Name:MOORES MILL DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:WASHBURN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:334-750-5720
Mailing Address - Street 1:2164 MOORES MILL RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-8447
Mailing Address - Country:US
Mailing Address - Phone:334-750-5720
Mailing Address - Fax:334-209-0515
Practice Address - Street 1:2164 MOORES MILL RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-8447
Practice Address - Country:US
Practice Address - Phone:334-750-5720
Practice Address - Fax:334-209-0515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-26
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5247122300000X
AL5120122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty