Provider Demographics
NPI:1184140121
Name:ACCESS DENTAL CARE, LLC
Entity type:Organization
Organization Name:ACCESS DENTAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASSEN
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:ANTHONY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:256-431-3184
Mailing Address - Street 1:1621 WOLVERINE DR SE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-4933
Mailing Address - Country:US
Mailing Address - Phone:256-431-3184
Mailing Address - Fax:
Practice Address - Street 1:1621 WOLVERINE DR SE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-4933
Practice Address - Country:US
Practice Address - Phone:256-431-3184
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty