Provider Demographics
NPI:1295890515
Name:NORTHCUTT DENTAL PRACTICE
Entity type:Organization
Organization Name:NORTHCUTT DENTAL PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:NORTHCUTT
Authorized Official - Suffix:III
Authorized Official - Credentials:DMD
Authorized Official - Phone:251-928-8770
Mailing Address - Street 1:23678 US HIGHWAY 98
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-3336
Mailing Address - Country:US
Mailing Address - Phone:251-928-8770
Mailing Address - Fax:251-928-8724
Practice Address - Street 1:23678 US HIGHWAY 98
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-3336
Practice Address - Country:US
Practice Address - Phone:251-928-8770
Practice Address - Fax:251-928-8724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL45931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL=========OtherDENTIST OFFICE