Provider Demographics
NPI:1922521350
Name:SOUTHERN PERIODONTICS, PC
Entity Type:Organization
Organization Name:SOUTHERN PERIODONTICS, PC
Other - Org Name:SOUTHERN PERIODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:COTY
Authorized Official - Middle Name:
Authorized Official - Last Name:HULGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:256-467-3638
Mailing Address - Street 1:427 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-5281
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:427 S 4TH ST
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-5281
Practice Address - Country:US
Practice Address - Phone:256-467-3638
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-18
Last Update Date:2017-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL61241223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty