Dothan Smiles Youth Dentistry, PC
Dentist, General Practice in Dothan, AL. Organization (NPI-2).
NPI number1548487531
StatusActive
Last updated in NPPESJul 9, 2014
Details
- NPI
- 1548487531
- Entity type
- Organization (NPI-2)
- Legal business name
- Dothan Smiles Youth Dentistry, PC
- Organization subpart
- No
- Enumeration date
- Apr 19, 2007
- Last updated
- Jul 9, 2014
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | – | – | Yes |
Practice location
5412 Montgomery HwySuite 8
Dothan, AL 36303-1657
Phone 334-983-1730 · Fax 334-983-1725
Mailing address
16 Arcade Unit 198747Nashville, TN 37219-1994
Phone 615-750-0343 · Fax 615-986-1705
Authorized official
Jenell Stump
Manager - Licensing & Credentialing
6157500343
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