Provider Demographics
NPI:1851488233
Name:SHOALS PEDIATRIC DENTISTRY, P.C.
Entity Type:Organization
Organization Name:SHOALS PEDIATRIC DENTISTRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:E
Authorized Official - Last Name:LENTS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:256-760-5660
Mailing Address - Street 1:640 COX CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-1105
Mailing Address - Country:US
Mailing Address - Phone:256-760-5660
Mailing Address - Fax:256-760-4681
Practice Address - Street 1:640 COX CREEK PKWY
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-1105
Practice Address - Country:US
Practice Address - Phone:256-760-5660
Practice Address - Fax:256-760-4681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL51111223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty