Provider Demographics
NPI:1790448769
Name:SINGING RIVER DENTISTRY TREEHOUSE, LLC
Entity Type:Organization
Organization Name:SINGING RIVER DENTISTRY TREEHOUSE, LLC
Other - Org Name:SINGING RIVER DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTYN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:256-320-5903
Mailing Address - Street 1:7559 HIGHWAY 72 W STE 108
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-8816
Mailing Address - Country:US
Mailing Address - Phone:256-653-9830
Mailing Address - Fax:256-469-7905
Practice Address - Street 1:7559 HIGHWAY 72 W STE 108
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-8816
Practice Address - Country:US
Practice Address - Phone:256-653-9830
Practice Address - Fax:256-469-7905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-18
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty