NPIMap

Organization Active NPI

Complete Dental Decatur LLC

  • General Practice Dentistry
  • Decatur, AL
National Provider Identifier
1366794711
Registry record updated Oct 10, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
5311 Issued in AL
Legal business name
COMPLETE DENTAL DECATUR LLC
Practice address
1241 Point Mallard Parkway
Suite. 105
Decatur, AL 35601
Phone
(256) 258-3866
NPI assigned
Oct 10, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2012

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

Authorized official

Name
Mrs. Teresa Janette Haake
Title
Billing Coordinator
Phone
(256) 258-3883

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 5311 AL Primary

Addresses

Primary practice location

1241 Point Mallard Parkway
Suite. 105
Decatur, AL 35601

Mailing address

120 W Dublin Dr
Suite. 202
Madison, AL 35758-3155
Phone (256) 258-3866

National Provider Directory

National Provider Directory
Tax ID family
Complete Dental Center LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1241 Point Mallard Pkwy
Ste 105
Decatur, AL 35601
Phone (256) 258-3866

NPI Registry JSON

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

{
    "created_epoch": "1349827200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349827200000",
    "number": "1366794711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 W DUBLIN DR",
            "address_2": "SUITE. 202",
            "city": "MADISON",
            "state": "AL",
            "postal_code": "357583155",
            "telephone_number": "256-258-3866",
            "fax_number": "256-464-5763"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1241 POINT MALLARD PARKWAY",
            "address_2": "SUITE. 105",
            "city": "DECATUR",
            "state": "AL",
            "postal_code": "35601",
            "telephone_number": "256-258-3866"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMPLETE DENTAL DECATUR LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-10",
        "last_updated": "2012-10-10",
        "status": "A",
        "authorized_official_last_name": "HAAKE",
        "authorized_official_first_name": "TERESA",
        "authorized_official_middle_name": "JANETTE",
        "authorized_official_title_or_position": "BILLING COORDINATOR",
        "authorized_official_telephone_number": "256-258-3883",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "AL",
            "license": "5311",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Decatur, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2012; 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.