NPIMap

Organization Active NPI

Alabama Dental Professionals PC

Doing business as Broad Street Dental Care

  • Dentist
  • Scottsboro, AL
National Provider Identifier
1851697643
Registry record updated Nov 8, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
4762 Issued in AL
Legal business name
ALABAMA DENTAL PROFESSIONALS PC
Doing business as
Broad Street Dental Care
Practice address
1202 S Broad St
Scottsboro, AL 35768-2512
Phone
(256) 259-5955
Fax
(256) 259-5954
NPI assigned
Jan 27, 2011
Last updated
Nov 8, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
ALABAMA DENTAL PROFESSIONALS PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 8, 2019

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

Authorized official

Name
Kim Zuber
Title
Cred Sup
Phone
(217) 540-5170

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 4762 AL Primary
Customized Equipment (DME) 332BC3200X 4762 AL

Addresses

Primary practice location

1202 S Broad St
Scottsboro, AL 35768-2512

Mailing address

1202 S Broad St
Scottsboro, AL 35768-2512
Phone (256) 259-5955

Other names 1

  • Broad Street Dental Care Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Alabama Dental Professionals PC21 organizations share this tax ID, including this one
Part of
Alabama Dental Professionals PC

Other organizations with this tax ID 20

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

View all 20

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1296086400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1573171200000",
    "number": "1851697643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1202 S BROAD ST",
            "city": "SCOTTSBORO",
            "state": "AL",
            "postal_code": "357682512",
            "telephone_number": "256-259-5955",
            "fax_number": "256-259-5954"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1202 S BROAD ST",
            "city": "SCOTTSBORO",
            "state": "AL",
            "postal_code": "357682512",
            "telephone_number": "256-259-5955",
            "fax_number": "256-259-5954"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALABAMA DENTAL PROFESSIONALS PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ALABAMA DENTAL PROFESSIONALS PC",
        "enumeration_date": "2011-01-27",
        "last_updated": "2019-11-08",
        "status": "A",
        "authorized_official_last_name": "ZUBER",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "CRED SUP",
        "authorized_official_telephone_number": "217-540-5170"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "AL",
            "license": "4762",
            "primary": true
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "AL",
            "license": "4762",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Broad Street Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Scottsboro, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2019; 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.