Provider Demographics
NPI:1487817987
Name:SOUTHERN DENTISTRY, P.C.
Entity Type:Organization
Organization Name:SOUTHERN DENTISTRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:NEBRIG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:251-621-1301
Mailing Address - Street 1:8477A COUNTY ROAD 64
Mailing Address - Street 2:SUITE 3
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-8714
Mailing Address - Country:US
Mailing Address - Phone:251-621-1301
Mailing Address - Fax:
Practice Address - Street 1:8477A COUNTY ROAD 64
Practice Address - Street 2:SUITE 3
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-8714
Practice Address - Country:US
Practice Address - Phone:251-621-1301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL55091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty