Provider Demographics
NPI:1699188508
Name:MERIDIANVILLE DENTAL, LLC
Entity Type:Organization
Organization Name:MERIDIANVILLE DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARTON
Authorized Official - Middle Name:TIMOTHY
Authorized Official - Last Name:BARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:256-828-1500
Mailing Address - Street 1:11808 HIGHWAY 231 431 N
Mailing Address - Street 2:
Mailing Address - City:MERIDIANVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35759-2126
Mailing Address - Country:US
Mailing Address - Phone:256-828-1500
Mailing Address - Fax:256-828-1515
Practice Address - Street 1:11808 HIGHWAY 231 431 N
Practice Address - Street 2:
Practice Address - City:MERIDIANVILLE
Practice Address - State:AL
Practice Address - Zip Code:35759-2126
Practice Address - Country:US
Practice Address - Phone:256-828-1500
Practice Address - Fax:256-828-1515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5814122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty