Provider Demographics
NPI:1255053146
Name:DRTBC, LLC
Entity type:Organization
Organization Name:DRTBC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:BRENT
Authorized Official - Last Name:CHURCH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-478-3569
Mailing Address - Street 1:3041 ALLISON-BONNETT MEMORIAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:HUEYTOWN
Mailing Address - State:AL
Mailing Address - Zip Code:35023
Mailing Address - Country:US
Mailing Address - Phone:205-224-0426
Mailing Address - Fax:
Practice Address - Street 1:3041 ALLISON-BONNETT MEMORIAL DRIVE
Practice Address - Street 2:
Practice Address - City:HUEYTOWN
Practice Address - State:AL
Practice Address - Zip Code:35023
Practice Address - Country:US
Practice Address - Phone:205-224-0426
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-16
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental