Provider Demographics
NPI:1588843635
Name:TUSCALOOSA PEDIATRIC DENTISTRY, P.C.
Entity Type:Organization
Organization Name:TUSCALOOSA PEDIATRIC DENTISTRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:HOLLOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-556-6100
Mailing Address - Street 1:2415 VETERANS MEMORIAL PKWY
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35404-4137
Mailing Address - Country:US
Mailing Address - Phone:205-556-6100
Mailing Address - Fax:205-556-6755
Practice Address - Street 1:2415 VETERANS MEMORIAL PKWY
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404-4137
Practice Address - Country:US
Practice Address - Phone:205-556-6100
Practice Address - Fax:205-556-6755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL54471223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty