Provider Demographics
NPI:1922514199
Name:DENTAL ASSOCIATES OF HAMPTON COVE LLC
Entity Type:Organization
Organization Name:DENTAL ASSOCIATES OF HAMPTON COVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/ PARTNER OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LORRIE
Authorized Official - Middle Name:BRACE
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:915-217-8763
Mailing Address - Street 1:6838B HIGHWAY 431 S STE B
Mailing Address - Street 2:
Mailing Address - City:OWENS CROSS ROADS
Mailing Address - State:AL
Mailing Address - Zip Code:35763-9224
Mailing Address - Country:US
Mailing Address - Phone:256-536-8120
Mailing Address - Fax:256-536-8154
Practice Address - Street 1:6838 HIGHWAY 431 S STE B
Practice Address - Street 2:
Practice Address - City:OWENS CROSS ROADS
Practice Address - State:AL
Practice Address - Zip Code:35763-7201
Practice Address - Country:US
Practice Address - Phone:256-536-8120
Practice Address - Fax:256-536-8154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-23
Last Update Date:2017-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALD6202261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental