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136 Plaza Blvd Suite A Madison AL 35758-1160 | |
| (256) 464-3556 | |
| (256) 464-3553 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 136 Plaza Blvd, Madison, Alabama |
| Authorized Official Name and Position | Heather Pruemer (CREDENTIALING TEAM LEAD) |
| Authorized Official Contact | 2175408434 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
136 Plaza Blvd Suite A Madison AL 35758-1160 Ph: (256) 464-3556 | 136 Plaza Blvd Suite A Madison AL 35758-1160 Ph: (256) 464-3556 |
| NPI Number | 1851498059 |
|---|---|
| Provider Enumeration Date | 09/20/2006 |
| Last Update Date | 08/01/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851498059 | NPI | - | NPPES |
| 515-09614 | Other | AL | BCBS OF AL PROVIDER NUMBE |
| 515-34033 | Other | AL | BCBS OF AL PROVIDER NUMBE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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