Provider Demographics
NPI:1942340765
Name:PRICE DENTON ENDODONTICS,LLC
Entity Type:Organization
Organization Name:PRICE DENTON ENDODONTICS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RECEPTIONIST
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:E
Authorized Official - Last Name:FUNKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-533-3480
Mailing Address - Street 1:2410 L AND N DR SW
Mailing Address - Street 2:SUITE B
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-5326
Mailing Address - Country:US
Mailing Address - Phone:256-533-3480
Mailing Address - Fax:256-534-6915
Practice Address - Street 1:2410 L AND N DR SW
Practice Address - Street 2:SUITE B
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5326
Practice Address - Country:US
Practice Address - Phone:256-533-3480
Practice Address - Fax:256-534-6915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL34511223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty