Sand Mountain Family Dentistry LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

SAND MOUNTAIN FAMILY DENTISTRY LLC

Practice address

701 Medical Center Pkwy
Boaz, AL 35957-5938

Phone

(205) 467-0387

NPI assigned

Apr 26, 2021

Organization subpart

No

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

Authorized official

Name

Dr. Brant Haynie, DMDNPI 1134409592

Title

Owner/Dentist

Phone

(205) 467-0387

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Practitioners 1

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

• Brant Daniel Haynie, D.M.D

  • Dentist
  • Rainbow City, AL
  • NPI 1134409592
  NPD Authorized official

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

{
    "created_epoch": "1619395200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621382400000",
    "number": "1790367126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 DOGWOOD CIR",
            "city": "GADSDEN",
            "state": "AL",
            "postal_code": "359015601",
            "telephone_number": "205-467-0387"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 MEDICAL CENTER PKWY",
            "city": "BOAZ",
            "state": "AL",
            "postal_code": "359575938",
            "telephone_number": "205-467-0387"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAND MOUNTAIN FAMILY DENTISTRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-26",
        "last_updated": "2021-05-19",
        "certification_date": "2021-05-19",
        "status": "A",
        "authorized_official_last_name": "HAYNIE",
        "authorized_official_first_name": "BRANT",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "205-467-0387",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "171653",
            "state": "AL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Boaz",
            "affiliation": "N",
            "address_1": "701 Medical Center Pkwy",
            "city": "Boaz",
            "state": "AL",
            "country_code": "US",
            "postal_code": "359575938",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jill Bethany Roberts, MD
• Rockridge Dialysis LLC
• Robert Miller Rosser
• Lauren Rosson
• Leon Rubin, COTA
• Alissa C Schuh, MD
• Patrick Sellers, CRNP
• Shifting Perspectives LLC
• Jeremy Allen Shultz, CRNP
• Donald F Slappey, MD

• Dental Clinic/Center in Boaz, AL
• Providers in Boaz, AL by specialty
• Dental Clinic/Center in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2021; 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.