Provider Demographics
NPI:1568012904
Name:COMPLETE DENTAL MERIDIANVILLE, LLC
Entity Type:Organization
Organization Name:COMPLETE DENTAL MERIDIANVILLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAMBLESS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:256-774-7228
Mailing Address - Street 1:120 W DUBLIN DR STE 202
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-3157
Mailing Address - Country:US
Mailing Address - Phone:256-774-7228
Mailing Address - Fax:256-464-5763
Practice Address - Street 1:11808 HIGHWAY 231 431 N
Practice Address - Street 2:
Practice Address - City:MERIDIANVILLE
Practice Address - State:AL
Practice Address - Zip Code:35759-2126
Practice Address - Country:US
Practice Address - Phone:256-774-7228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MADISON DENTAL CENTER L.L.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty