Provider Demographics
NPI:1982002150
Name:AULTMAN DENTAL
Entity Type:Organization
Organization Name:AULTMAN DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:AULTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:205-812-2005
Mailing Address - Street 1:2043 MARTIN ST S
Mailing Address - Street 2:
Mailing Address - City:PELL CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35128-2329
Mailing Address - Country:US
Mailing Address - Phone:205-812-2005
Mailing Address - Fax:205-812-2007
Practice Address - Street 1:2043 MARTIN ST S
Practice Address - Street 2:
Practice Address - City:PELL CITY
Practice Address - State:AL
Practice Address - Zip Code:35128-2329
Practice Address - Country:US
Practice Address - Phone:205-812-2005
Practice Address - Fax:205-812-2007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-19
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6085261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental