NPIMap

Alabama Dental Professionals, P.C.

Organization Active NPI General Practice Dentistry · Madison, AL

NPI 1851498059 · NPPES record last updated Aug 1, 2017

Key facts

NPI
1851498059
Entity type
Organization (NPI type 2)
Primary specialty
General Practice Dentistry 1223G0001X
Legal business name
ALABAMA DENTAL PROFESSIONALS, P.C.
Practice address
136 Plaza Blvd
Suite a
Madison, AL 35758-1160
Phone
(256) 464-3556
Fax
(256) 464-3553
NPI assigned
Sep 20, 2006
Organization subpart
Yes
Parent organization (as reported)
ALABAMA DENTAL PROFESSIONALS, P.C.

Authorized official

Name
Heather Pruemer
Title
Credentialing Team Lead
Phone
(217) 540-8434

Corporate family (same tax ID) 20

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

National Provider Directory

Tax ID family
Alabama Dental Professionals PC (21 organizations share this tax ID)
Part of
Alabama Dental Professionals PC

Locations

136 Plaza Blvd
Ste A
Madison, AL 35758
Phone (256) 464-3556

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry
Group: 193200000X MULTI-SPECIALTY GROUP		 1223G0001X Yes

Addresses

Primary practice location

136 Plaza Blvd
Suite a
Madison, AL 35758-1160

Mailing address

136 Plaza Blvd
Suite a
Madison, AL 35758-1160
Phone (256) 464-3556

Other identifiers

IdentifierTypeStateIssuer
515-09614OtherALBCBS OF AL PROVIDER NUMBE
515-34033OtherALBCBS OF AL PROVIDER NUMBE

Other names

  • Plaza Boulevard Dental Doing business as
  • Rousseau Family Dentistry Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 1, 2017.

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1501545600000",
    "number": "1851498059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "136 PLAZA BLVD",
            "address_2": "SUITE A",
            "city": "MADISON",
            "state": "AL",
            "postal_code": "357581160",
            "telephone_number": "256-464-3556",
            "fax_number": "256-464-3553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "136 PLAZA BLVD",
            "address_2": "SUITE A",
            "city": "MADISON",
            "state": "AL",
            "postal_code": "357581160",
            "telephone_number": "256-464-3556",
            "fax_number": "256-464-3553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALABAMA DENTAL PROFESSIONALS, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ALABAMA DENTAL PROFESSIONALS, P.C.",
        "enumeration_date": "2006-09-20",
        "last_updated": "2017-08-01",
        "status": "A",
        "authorized_official_last_name": "PRUEMER",
        "authorized_official_first_name": "HEATHER",
        "authorized_official_title_or_position": "CREDENTIALING TEAM LEAD",
        "authorized_official_telephone_number": "217-540-8434"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF AL PROVIDER NUMBE",
            "identifier": "515-09614",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF AL PROVIDER NUMBE",
            "identifier": "515-34033",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Plaza Boulevard Dental",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Rousseau Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Madison, AL

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

Sources for this page

Verify at the official NPI Registry.