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7559 Highway 72 W Ste 108 Madison AL 35758-8816 | |
| (256) 653-9830 | |
| (256) 469-7905 |
| Full Name | |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 7559 Highway 72 W Ste 108, Madison, Alabama |
| Authorized Official Name and Position | Christyn Shields (CONTROLLER) |
| Authorized Official Contact | 2563205903 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
7559 Highway 72 W Ste 108 Madison AL 35758-8816 Ph: (256) 653-9830 | 7559 Highway 72 W Ste 108 Madison AL 35758-8816 Ph: (256) 653-9830 |
| NPI Number | 1790448769 |
|---|---|
| Provider Enumeration Date | 10/18/2021 |
| Last Update Date | 07/06/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790448769 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |
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