Provider Demographics
NPI:1497933253
Name:EAST ALABAMA PEDIATRIC DENTISTRY & ORTHODONTICS
Entity Type:Organization
Organization Name:EAST ALABAMA PEDIATRIC DENTISTRY & ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BUFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-321-0780
Mailing Address - Street 1:742 N DEAN RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-4300
Mailing Address - Country:US
Mailing Address - Phone:334-321-0780
Mailing Address - Fax:
Practice Address - Street 1:742 N DEAN RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-4300
Practice Address - Country:US
Practice Address - Phone:334-321-0780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-04
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL52211223P0221X
AL1223PO221X1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty