SRD Florence, PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

SRD FLORENCE, PLLC

Practice address

2604 Hough Rd
Florence, AL 35630-1747

Phone

(256) 764-9955

Fax

(256) 764-9424

NPI assigned

Jun 20, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Christyn Shields

Title

Controlled

Phone

(256) 320-5903

Specialties & licenses 1

Addresses

Other names 1

• Singing River Dentistry Florence Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1655683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657065600000",
    "number": "1225769409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 740979",
            "city": "TUSCUMBIA",
            "state": "AL",
            "postal_code": "356747423"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2604 HOUGH RD",
            "city": "FLORENCE",
            "state": "AL",
            "postal_code": "356301747",
            "telephone_number": "256-764-9955",
            "fax_number": "256-764-9424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SRD FLORENCE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-20",
        "last_updated": "2022-07-06",
        "certification_date": "2022-07-06",
        "status": "A",
        "authorized_official_last_name": "SHIELDS",
        "authorized_official_first_name": "CHRISTYN",
        "authorized_official_title_or_position": "CONTROLLED",
        "authorized_official_telephone_number": "256-320-5903"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Singing River Dentistry Florence",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Singing River Dentistry Florence",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Gwen Virginia Stackhouse, CRNA
• William Ralph Stackhouse, CRNA

• General Practice Dentistry in Florence, AL
• Providers in Florence, AL by specialty
• General Practice Dentistry in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.