Alabama Dental Professionals PC
Dentist in Scottsboro, AL. Organization (NPI-2).
NPI number1851697643
StatusActive
Last updated in NPPESNov 8, 2019
Details
- NPI
- 1851697643
- Entity type
- Organization (NPI-2)
- Legal business name
- Alabama Dental Professionals PC
- Organization subpart
- Yes
- Enumeration date
- Jan 27, 2011
- Last updated
- Nov 8, 2019
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 122300000X | Dentist | 4762 | AL | Yes |
| 332BC3200X | Durable Medical Equipment & Medical Supplies, Customized Equipment | 4762 | AL |
Other names
- Broad Street Dental Care (Doing Business As)
Practice location
1202 S Broad StScottsboro, AL 35768-2512
Phone 256-259-5955 · Fax 256-259-5954
Mailing address
1202 S Broad StScottsboro, AL 35768-2512
Phone 256-259-5955 · Fax 256-259-5954
Authorized official
Kim Zuber
Cred Sup
2175405170
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