Provider Demographics
NPI:1629452636
Name:DENTREMONT DENTAL SERVICES PC
Entity Type:Organization
Organization Name:DENTREMONT DENTAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANKLIN
Authorized Official - Middle Name:ALCIDE
Authorized Official - Last Name:DENTREMONT
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:251-943-0004
Mailing Address - Street 1:3501 GULF SHORES PKWY
Mailing Address - Street 2:SUITE 4
Mailing Address - City:GULF SHORES
Mailing Address - State:AL
Mailing Address - Zip Code:36542-5710
Mailing Address - Country:US
Mailing Address - Phone:251-943-0004
Mailing Address - Fax:844-208-8385
Practice Address - Street 1:3501 GULF SHORES PKWY
Practice Address - Street 2:SUITE 4
Practice Address - City:GULF SHORES
Practice Address - State:AL
Practice Address - Zip Code:36542-5710
Practice Address - Country:US
Practice Address - Phone:251-943-0004
Practice Address - Fax:844-208-8385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-20
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL40211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty