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11521 Us Highway 431 Ste V Guntersville AL 35976-5671 | |
| (256) 505-8954 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 11521 Us Highway 431 Ste V, Guntersville, Alabama |
| Authorized Official Name and Position | Matthew Ticola (MANAGER) |
| Authorized Official Contact | 2565058954 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
11521 Us Highway 431 Ste V Guntersville AL 35976-5671 Ph: () - | 11521 Us Highway 431 Ste V Guntersville AL 35976-5671 Ph: (256) 505-8954 |
| NPI Number | 1699202960 |
|---|---|
| Provider Enumeration Date | 05/17/2017 |
| Last Update Date | 05/17/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699202960 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | D0005747-C (Alabama) | Primary |
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