Provider Demographics
NPI:1922783349
Name:SOUTHERN PEDODONTICS PARTNERS, LLC
Entity Type:Organization
Organization Name:SOUTHERN PEDODONTICS PARTNERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLIMANS
Authorized Official - Suffix:III
Authorized Official - Credentials:DMD
Authorized Official - Phone:334-718-3787
Mailing Address - Street 1:240 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-1346
Mailing Address - Country:US
Mailing Address - Phone:334-718-3787
Mailing Address - Fax:
Practice Address - Street 1:102 METRO DR
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-1985
Practice Address - Country:US
Practice Address - Phone:334-792-1962
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty