Provider Demographics
NPI:1578239992
Name:NKO DENTAL AL PLLC
Entity Type:Organization
Organization Name:NKO DENTAL AL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-512-1839
Mailing Address - Street 1:403 E COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:TN
Mailing Address - Zip Code:38478-4315
Mailing Address - Country:US
Mailing Address - Phone:931-363-1388
Mailing Address - Fax:931-363-1388
Practice Address - Street 1:721 W MARKET ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611-2456
Practice Address - Country:US
Practice Address - Phone:256-232-3415
Practice Address - Fax:256-230-2648
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VIBE DENTAL GROUP AL, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty