Organization · NPI-2

Aesthetic And Reconstructive Dentistry, LLC

Dentist, Prosthodontics · Madison, AL

NPI number1902297690
StatusActive
Last updated in NPPESFeb 17, 2015

Details

NPI
1902297690
Entity type
Organization (NPI-2)
Legal business name
Aesthetic And Reconstructive Dentistry, LLC
Organization subpart
No
Enumeration date
Feb 17, 2015
Last updated
Feb 17, 2015

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
1223P0700X Dentist, Prosthodontics5928ALYes
292200000X Dental Laboratory233720-00AL

Other names

  • Madison Prosthodontics: Aesthetic And Reconstructive Dentistry, LLC (Doing Business As)

Practice location

1041 Balch Rd
Suite 180
Madison, AL 35758-8343

Phone 256-319-3256 · Fax 256-319-3257

Mailing address

1041 Balch Rd
Suite 180
Madison, AL 35758-8343

Phone 256-319-3256 · Fax 256-319-3257

Authorized official

Cramin Peter Wiltz
Sole Member
2563193256

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