Provider Demographics
NPI:1558879817
Name:TUSCALOOSA FAMILY DENTAL, LLC
Entity Type:Organization
Organization Name:TUSCALOOSA FAMILY DENTAL, LLC
Other - Org Name:TUSCALOOSA FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:PARKER
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:205-451-3010
Mailing Address - Street 1:1304 TREE CROSSINGS PKWY
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-4051
Mailing Address - Country:US
Mailing Address - Phone:205-451-3010
Mailing Address - Fax:
Practice Address - Street 1:7402 HIGHWAY 69 S
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35405-1300
Practice Address - Country:US
Practice Address - Phone:205-451-3010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-19
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL60391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty