Provider Demographics
NPI:1912633900
Name:AUBURN IMPLANT DENTISTRY, LLC
Entity Type:Organization
Organization Name:AUBURN IMPLANT DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERIODONTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRITANY
Authorized Official - Middle Name:FABIAN
Authorized Official - Last Name:MATIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:334-209-1352
Mailing Address - Street 1:670 N COLLEGE ST STE D
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-3030
Mailing Address - Country:US
Mailing Address - Phone:334-209-1352
Mailing Address - Fax:
Practice Address - Street 1:670 N COLLEGE ST STE D
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-3030
Practice Address - Country:US
Practice Address - Phone:334-209-1352
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-01
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty