Provider Demographics
NPI:1982907473
Name:CGF DDS PC
Entity Type:Organization
Organization Name:CGF DDS PC
Other - Org Name:BAILEY COVE FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CLIFTON
Authorized Official - Middle Name:
Authorized Official - Last Name:FRAZIER
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:256-650-0724
Mailing Address - Street 1:10300 BAILEY COVE RD SE
Mailing Address - Street 2:STE 4
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35803-2635
Mailing Address - Country:US
Mailing Address - Phone:256-650-0724
Mailing Address - Fax:256-650-0872
Practice Address - Street 1:10300 BAILEY COVE RD SE
Practice Address - Street 2:STE 4
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35803-2635
Practice Address - Country:US
Practice Address - Phone:256-650-0724
Practice Address - Fax:256-650-0872
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CGF DDS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-12-06
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Multi-Specialty