Provider Demographics
NPI:1689063711
Name:LEIGH ANNE NEVINS, DMD, PC
Entity Type:Organization
Organization Name:LEIGH ANNE NEVINS, DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF PC
Authorized Official - Prefix:DR
Authorized Official - First Name:LEIGH ANNE
Authorized Official - Middle Name:T
Authorized Official - Last Name:NEVINS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:334-467-1817
Mailing Address - Street 1:454 MCQUEEN SMITH RD S
Mailing Address - Street 2:
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36066-5631
Mailing Address - Country:US
Mailing Address - Phone:334-380-9170
Mailing Address - Fax:334-380-9173
Practice Address - Street 1:454 MCQUEEN SMITH RD S
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36066-5631
Practice Address - Country:US
Practice Address - Phone:334-380-9170
Practice Address - Fax:334-380-9173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4591261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental