Medwell Duncan Dental

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

5395 Issued in AL

Legal business name

MEDWELL DUNCAN DENTAL

Practice address

2705 Pelham Pkwy
Pelham, AL 35124-1704

Phone

(205) 253-3593

NPI assigned

Mar 15, 2012

Organization subpart

No

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

Authorized official

Name

Shaunda Kelly, MD

Title

Ceo

Phone

(205) 514-7390

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1331769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1331769600000",
    "number": "1942575444",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "455 SUNBELT PKWY",
            "city": "BESSEMER",
            "state": "AL",
            "postal_code": "350223902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2705 PELHAM PKWY",
            "city": "PELHAM",
            "state": "AL",
            "postal_code": "351241704",
            "telephone_number": "205-253-3593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDWELL DUNCAN DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-15",
        "last_updated": "2012-03-15",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "SHAUNDA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "205-514-7390",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "AL",
            "license": "5395",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Pelham, AL
• Oral and Maxillofacial Surgery (Dentist) in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 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.