Provider Demographics
NPI:1598066839
Name:ALGOOD FAMILY DENTAL GROUP
Entity Type:Organization
Organization Name:ALGOOD FAMILY DENTAL GROUP
Other - Org Name:ALGOOD FAMILY DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:F
Authorized Official - Last Name:HEARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:931-537-9948
Mailing Address - Street 1:172 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38506-5337
Mailing Address - Country:US
Mailing Address - Phone:931-537-9948
Mailing Address - Fax:931-537-2808
Practice Address - Street 1:172 W MAIN ST
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38506-5337
Practice Address - Country:US
Practice Address - Phone:931-537-9948
Practice Address - Fax:931-537-2808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN81301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty