Provider Demographics
NPI:1992827885
Name:CHELSEA FAMILY DENTISTRY, PC
Entity Type:Organization
Organization Name:CHELSEA FAMILY DENTISTRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DMD
Authorized Official - Prefix:DR
Authorized Official - First Name:L.
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-678-2096
Mailing Address - Street 1:300 JADE PARK,
Mailing Address - Street 2:STE 302
Mailing Address - City:CHELSEA
Mailing Address - State:AL
Mailing Address - Zip Code:35043
Mailing Address - Country:US
Mailing Address - Phone:205-678-2096
Mailing Address - Fax:205-678-2098
Practice Address - Street 1:300 JADE PARK,
Practice Address - Street 2:STE 302
Practice Address - City:CHELSEA
Practice Address - State:AL
Practice Address - Zip Code:35043
Practice Address - Country:US
Practice Address - Phone:205-678-2096
Practice Address - Fax:205-678-2098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL48511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL5299311090Medicaid
AL348510OtherUNITED CONCORDIA
AL5299311090Medicaid