Provider Demographics
NPI:1659594216
Name:ZELDA COURT DENTAL CARE LLC
Entity Type:Organization
Organization Name:ZELDA COURT DENTAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FORREST
Authorized Official - Middle Name:E
Authorized Official - Last Name:WATERS
Authorized Official - Suffix:III
Authorized Official - Credentials:DMD
Authorized Official - Phone:334-281-2451
Mailing Address - Street 1:3150 ZELDA COURT
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106
Mailing Address - Country:US
Mailing Address - Phone:334-281-2451
Mailing Address - Fax:334-281-1087
Practice Address - Street 1:3150 ZELDA COURT
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106
Practice Address - Country:US
Practice Address - Phone:334-281-2451
Practice Address - Fax:334-281-1087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4029122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty