Provider Demographics
NPI:1811229891
Name:AFFORDABLE FAMILY DENTISTRY P.C.
Entity Type:Organization
Organization Name:AFFORDABLE FAMILY DENTISTRY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:WADE
Authorized Official - Last Name:DUBE
Authorized Official - Suffix:I
Authorized Official - Credentials:DMD
Authorized Official - Phone:256-352-4422
Mailing Address - Street 1:P.O. BOX 353
Mailing Address - Street 2:
Mailing Address - City:HANCEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35077
Mailing Address - Country:US
Mailing Address - Phone:256-352-4422
Mailing Address - Fax:
Practice Address - Street 1:1096 COUNTRY ROAD 1579
Practice Address - Street 2:
Practice Address - City:CULLMAR
Practice Address - State:AL
Practice Address - Zip Code:35058
Practice Address - Country:US
Practice Address - Phone:256-352-4422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5072122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty