Provider Demographics
NPI:1952844656
Name:MIDTOWN DENTAL LLC
Entity Type:Organization
Organization Name:MIDTOWN DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JUDD
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-594-6323
Mailing Address - Street 1:100 PROVIDENCE MAIN ST NW STE C
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35806-4827
Mailing Address - Country:US
Mailing Address - Phone:256-653-9830
Mailing Address - Fax:
Practice Address - Street 1:100 PROVIDENCE MAIN ST NW STE C
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35806-4827
Practice Address - Country:US
Practice Address - Phone:256-653-9830
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5665122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty