Provider Demographics
NPI:1528577129
Name:GENESIS DENTAL GROUP HOMEWOOD P.C.
Entity Type:Organization
Organization Name:GENESIS DENTAL GROUP HOMEWOOD P.C.
Other - Org Name:TURNIPSEED FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PAT
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-676-2320
Mailing Address - Street 1:3150 ZELDA CT
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-2607
Mailing Address - Country:US
Mailing Address - Phone:334-676-2320
Mailing Address - Fax:
Practice Address - Street 1:2045 BROOKWOOD MEDICAL CTR DR STE 4
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-6809
Practice Address - Country:US
Practice Address - Phone:205-871-6600
Practice Address - Fax:205-871-6680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-26
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL61381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty