Provider Demographics
NPI:1922133925
Name:DORSETT, CECIL RILEY (DMD)
Entity Type:Individual
Prefix:
First Name:CECIL
Middle Name:RILEY
Last Name:DORSETT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 GOODYEAR AVE
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35903-1107
Mailing Address - Country:US
Mailing Address - Phone:256-492-6363
Mailing Address - Fax:256-492-0047
Practice Address - Street 1:910 GOODYEAR AVE
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35903-1107
Practice Address - Country:US
Practice Address - Phone:256-492-6363
Practice Address - Fax:256-492-0047
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL35811223S0112X, 204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-00515OtherBLUE CROSS BLUE SHIELD
AL051500515Medicaid
AL515-00515OtherBLUE CROSS BLUE SHIELD
AL051500515Medicare ID - Type Unspecified