Provider Demographics
NPI:1851838833
Name:AL DENTAL PROFESSIONALS PC
Entity Type:Organization
Organization Name:AL DENTAL PROFESSIONALS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:BLAINE
Authorized Official - Last Name:DENTON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:615-620-5990
Mailing Address - Street 1:2505 21ST AVE S STE 204
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37212-5652
Mailing Address - Country:US
Mailing Address - Phone:615-620-5990
Mailing Address - Fax:888-702-3012
Practice Address - Street 1:1518 N BRINDLEE MOUNTAIN PKWY
Practice Address - Street 2:
Practice Address - City:ARAB
Practice Address - State:AL
Practice Address - Zip Code:35016-5723
Practice Address - Country:US
Practice Address - Phone:615-620-5990
Practice Address - Fax:888-702-3012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-27
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty