Provider Demographics
NPI:1578347365
Name:HUNTSVILLE PERIODONTAL AND IMPLANT SPECIALISTS, LLC
Entity Type:Organization
Organization Name:HUNTSVILLE PERIODONTAL AND IMPLANT SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRITANY
Authorized Official - Middle Name:FABIAN
Authorized Official - Last Name:MATIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:256-289-8440
Mailing Address - Street 1:7736 MADISON BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35806-3658
Mailing Address - Country:US
Mailing Address - Phone:256-289-8440
Mailing Address - Fax:256-257-9808
Practice Address - Street 1:7736 MADISON BLVD STE 2
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35806-3658
Practice Address - Country:US
Practice Address - Phone:256-289-8440
Practice Address - Fax:256-257-9808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty