Provider Demographics
NPI:1912328527
Name:MCADORY DENTAL CENTER, LLC
Entity Type:Organization
Organization Name:MCADORY DENTAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RECEPTIONIST
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-436-2683
Mailing Address - Street 1:4764 EASTERN VALLEY RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MC CALLA
Mailing Address - State:AL
Mailing Address - Zip Code:35111-3469
Mailing Address - Country:US
Mailing Address - Phone:205-436-2683
Mailing Address - Fax:205-436-2685
Practice Address - Street 1:4764 EASTERN VALLEY RD
Practice Address - Street 2:SUITE 104
Practice Address - City:MC CALLA
Practice Address - State:AL
Practice Address - Zip Code:35111-3469
Practice Address - Country:US
Practice Address - Phone:205-436-2683
Practice Address - Fax:205-436-2685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-27
Last Update Date:2013-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5334122300000X
AL5374122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty