Provider Demographics
NPI:1912677907
Name:VIBE DENTAL OF ATHENS PLLC
Entity Type:Organization
Organization Name:VIBE DENTAL OF ATHENS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-363-1388
Mailing Address - Street 1:721 W MARKET ST STE A
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35611-2456
Mailing Address - Country:US
Mailing Address - Phone:256-232-3415
Mailing Address - Fax:256-230-2648
Practice Address - Street 1:721 W MARKET ST STE A
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611-2456
Practice Address - Country:US
Practice Address - Phone:256-232-3415
Practice Address - Fax:256-230-2648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty