Southside Family & Cosmetic Dentistry, LLC

Organization Active NPI General Practice Dentistry · Southside, AL

NPI 1346583457 · NPPES record last updated Mar 27, 2013

Key facts

NPI
1346583457
Entity type
Organization (NPI type 2)
Primary specialty
General Practice Dentistry 1223G0001X
Legal business name
SOUTHSIDE FAMILY & COSMETIC DENTISTRY, LLC
Practice address
1745 Highway 77
Southside, AL 35907-0169
Phone
(256) 442-1463
Fax
(256) 442-9821
NPI assigned
Mar 27, 2013
Organization subpart
No

Authorized official

Name
Donna Jennings
Title
Office Manager
Phone
(256) 442-1463

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

National Provider Directory

Locations

1745 Highway 77
Southside, AL 35907
Phone (256) 442-1463

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry
Group: 193200000X MULTI-SPECIALTY GROUP
1223G0001X Yes
Dental Hygienist
Group: 193200000X MULTI-SPECIALTY GROUP
124Q00000X
Dental Assistant
Group: 193200000X MULTI-SPECIALTY GROUP
126800000X

Addresses

Primary practice location

1745 Highway 77
Southside, AL 35907-0169

Mailing address

1745 Highway 77
Southside, AL 35907-0169
Phone (256) 442-1463

Other providers in Southside, AL

All providers in Southside, AL · General Practice Dentistry in Alabama

Sources for this page

Verify at the official NPI Registry.