Provider Demographics
NPI:1942616651
Name:WILLIAM E. HARRELL, JR., DMD, PC
Entity Type:Organization
Organization Name:WILLIAM E. HARRELL, JR., DMD, PC
Other - Org Name:HARRELL ORTHODONTICS/TMJ/DENTAL SLEEP MEDICINE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:HARRELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:256-234-6353
Mailing Address - Street 1:163 ALABAMA ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDER CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35010-1934
Mailing Address - Country:US
Mailing Address - Phone:256-234-6353
Mailing Address - Fax:256-234-6713
Practice Address - Street 1:163 ALABAMA ST
Practice Address - Street 2:
Practice Address - City:ALEXANDER CITY
Practice Address - State:AL
Practice Address - Zip Code:35010-1934
Practice Address - Country:US
Practice Address - Phone:256-234-6353
Practice Address - Fax:256-234-6713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-02
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL31691223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL3000012539Medicaid