NPIMap

Organization Active NPI

Sarrell Regional Dental Center for Public Health, Inc.

  • Pediatric Dentistry
  • Selma, AL
National Provider Identifier
1417240482
Registry record updated Mar 28, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
SARRELL REGIONAL DENTAL CENTER FOR PUBLIC HEALTH, INC.
Practice address
1013 Medical Center Pkwy Ste 103
Selma, AL 36701-6742
Phone
(334) 410-1603
Fax
(334) 410-1604
NPI assigned
May 24, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2018

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

Authorized official

Name
Todd Cruse
Title
President
Phone
(629) 999-5006

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X Primary

Addresses

Primary practice location

1013 Medical Center Pkwy Ste 103
Selma, AL 36701-6742

Mailing address

230 E 10TH St Ste 106
Anniston, AL 36207-5771
Phone (256) 741-7340

Other identifiers 1

IdentifierTypeStateIssuer
128566MedicaidAL

National Provider Directory

National Provider Directory
Tax ID family
Advantage Dental Oral Health and Vision Center of Alabama PC31 organizations share this tax ID, including this one

Other organizations with this tax ID 30

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

View all 30

Locations

1013 Medical Center Pkwy
Ste 103
Selma, AL 36701
Phone (334) 410-1603

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1306195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1522195200000",
    "number": "1417240482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "230 E 10TH ST STE 106",
            "city": "ANNISTON",
            "state": "AL",
            "postal_code": "362075771",
            "telephone_number": "256-741-7340",
            "fax_number": "256-741-7373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1013 MEDICAL CENTER PKWY STE 103",
            "city": "SELMA",
            "state": "AL",
            "postal_code": "367016742",
            "telephone_number": "334-410-1603",
            "fax_number": "334-410-1604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SARRELL REGIONAL DENTAL CENTER FOR PUBLIC HEALTH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-24",
        "last_updated": "2018-03-28",
        "status": "A",
        "authorized_official_last_name": "CRUSE",
        "authorized_official_first_name": "TODD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "629-999-5006"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "128566",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Selma, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2018; 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.