Provider Demographics
NPI:1548404742
Name:ORANGE BEACH DENTAL PC
Entity Type:Organization
Organization Name:ORANGE BEACH DENTAL PC
Other - Org Name:PARADISE SMILES DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANKLIN
Authorized Official - Middle Name:ALCIDE
Authorized Official - Last Name:DENTREMONT
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:251-968-3431
Mailing Address - Street 1:PO BOX 34162
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32507-4162
Mailing Address - Country:US
Mailing Address - Phone:251-968-3431
Mailing Address - Fax:
Practice Address - Street 1:27250B PERDIDO BEACH BLVD
Practice Address - Street 2:
Practice Address - City:ORANGE BEACH
Practice Address - State:AL
Practice Address - Zip Code:36561-3205
Practice Address - Country:US
Practice Address - Phone:251-968-3431
Practice Address - Fax:850-512-1842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-01
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL40211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty