Provider Demographics
NPI:1861827115
Name:R.DAVID RODEN, JR.,DMD, MD, PC
Entity Type:Organization
Organization Name:R.DAVID RODEN, JR.,DMD, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:RODEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD, MD
Authorized Official - Phone:205-870-5834
Mailing Address - Street 1:1771 INDEPENDENCE CT
Mailing Address - Street 2:SUITE 2
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35216-1258
Mailing Address - Country:US
Mailing Address - Phone:205-870-5834
Mailing Address - Fax:205-870-1618
Practice Address - Street 1:1771 INDEPENDENCE CT
Practice Address - Street 2:SUITE 2
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35216-1258
Practice Address - Country:US
Practice Address - Phone:205-870-5834
Practice Address - Fax:205-870-1618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-05
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5228261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental