| Sand Mountain Family Dentistry Llc | |
|
701 Medical Center Pkwy Boaz AL 35957-5938 | |
| (205) 467-0387 | |
| Not Available |
| Full Name | Sand Mountain Family Dentistry Llc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 701 Medical Center Pkwy, Boaz, Alabama |
| Authorized Official Name and Position | Brant Haynie (OWNER/DENTIST) |
| Authorized Official Contact | 2054670387 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Sand Mountain Family Dentistry Llc 211 Dogwood Cir Gadsden AL 35901-5601 Ph: (205) 467-0387 | Sand Mountain Family Dentistry Llc 701 Medical Center Pkwy Boaz AL 35957-5938 Ph: (205) 467-0387 |
| NPI Number | 1790367126 |
|---|---|
| Provider Enumeration Date | 04/26/2021 |
| Last Update Date | 05/19/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790367126 | NPI | - | NPPES |
| 171653 | Medicaid | AL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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