Provider Demographics
NPI:1942461587
Name:COLUMBIANA FAMILY DENTISTRY, PC
Entity Type:Organization
Organization Name:COLUMBIANA FAMILY DENTISTRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:DOYLE
Authorized Official - Last Name:NETTLES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-669-6778
Mailing Address - Street 1:PO BOX 558
Mailing Address - Street 2:204 MILDRED STREET
Mailing Address - City:COLUMBIANA
Mailing Address - State:AL
Mailing Address - Zip Code:35051-0558
Mailing Address - Country:US
Mailing Address - Phone:205-669-6778
Mailing Address - Fax:205-669-6779
Practice Address - Street 1:204 MILDRED ST
Practice Address - Street 2:
Practice Address - City:COLUMBIANA
Practice Address - State:AL
Practice Address - Zip Code:35051-9330
Practice Address - Country:US
Practice Address - Phone:205-669-6778
Practice Address - Fax:205-669-6779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL52481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty