Provider Demographics
NPI:1013531532
Name:JRL, DMD, LLC
Entity type:Organization
Organization Name:JRL, DMD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:S
Authorized Official - Last Name:LESLIE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-239-0067
Mailing Address - Street 1:6905 ATLANTA HWY
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-4213
Mailing Address - Country:US
Mailing Address - Phone:205-239-0067
Mailing Address - Fax:334-270-0053
Practice Address - Street 1:6905 ATLANTA HWY
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-4213
Practice Address - Country:US
Practice Address - Phone:205-239-0067
Practice Address - Fax:334-270-0053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-01
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental