Provider Demographics
NPI:1831636885
Name:SBBW INC
Entity Type:Organization
Organization Name:SBBW INC
Other - Org Name:ORANGE BEACH FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:HOLLOWAY
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:334-714-5257
Mailing Address - Street 1:25299 CANAL RD
Mailing Address - Street 2:SUITE A5
Mailing Address - City:ORANGE BEACH
Mailing Address - State:AL
Mailing Address - Zip Code:36561-5814
Mailing Address - Country:US
Mailing Address - Phone:251-321-7575
Mailing Address - Fax:
Practice Address - Street 1:25299 CANAL RD
Practice Address - Street 2:SUITE A5
Practice Address - City:ORANGE BEACH
Practice Address - State:AL
Practice Address - Zip Code:36561-5814
Practice Address - Country:US
Practice Address - Phone:251-321-7575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-30
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6071 C11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty