Humana Dental Corporation

Key facts

NPI

1962558403

Entity type

Organization (NPI type 2)

Primary specialty

General Practice Dentistry 1223G0001X

Legal business name

HUMANA DENTAL CORPORATION

Practice address

4801 Cuba Millington Rd
Millington, TN 38053-5401

Phone

(318) 617-8665

Fax

(479) 252-6029

NPI assigned

Jan 26, 2007

Organization subpart

No

Authorized official

Name

Steve R Alexander

Title

Director of Operations

Phone

(318) 617-8665

Practitioners 1

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

• Angela Marascalco Skidmore, DDS General Practice Dentistry · Millington, TN · NPI 1730235268
  NPD (past) GENERAL PRACTICE

National Provider Directory

Locations

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Feb 21, 2012.

{
    "created_epoch": "1169769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329782400000",
    "number": "1962558403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1415",
            "city": "GREENWOOD",
            "state": "AR",
            "postal_code": "729361415",
            "telephone_number": "318-617-8665",
            "fax_number": "479-252-6029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4801 CUBA MILLINGTON RD",
            "city": "MILLINGTON",
            "state": "TN",
            "postal_code": "380535401",
            "telephone_number": "318-617-8665",
            "fax_number": "479-252-6029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HUMANA DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-26",
        "last_updated": "2012-02-21",
        "status": "A",
        "authorized_official_last_name": "ALEXANDER",
        "authorized_official_first_name": "STEVE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "318-617-8665"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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