Provider Demographics
NPI:1750024840
Name:SPANISH FORT DENTAL ASSOCIATES, LLC
Entity type:Organization
Organization Name:SPANISH FORT DENTAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:251-978-6028
Mailing Address - Street 1:5 AUDUBON PL
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-3001
Mailing Address - Country:US
Mailing Address - Phone:251-978-6029
Mailing Address - Fax:
Practice Address - Street 1:6450 US HIGHWAY 90 STE D
Practice Address - Street 2:
Practice Address - City:SPANISH FORT
Practice Address - State:AL
Practice Address - Zip Code:36527-9480
Practice Address - Country:US
Practice Address - Phone:251-626-7675
Practice Address - Fax:251-626-8194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-15
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental