# FRESH WAVE DENTAL CARE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134392517
- **Authorized official:** MRS. DEBBIELEE J HAWN (OFFICE MANGER)
- **Authorized official phone:** (334) 347-9283

## Contact information

- **Practice address:** 812 BOLL WEEVIL CIR, ENTERPRISE, AL 36330-2079
- **Practice address phone:** (334) 347-9283
- **Mailing address:** 812 BOLL WEEVIL CIR, ENTERPRISE, AL 36330-2079
- **Mailing address phone:** (334) 347-9283

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 4810 | AL | Yes |

## Other

- **Enumeration date:** 04/08/2008
- **Last updated:** 04/08/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 51027316 | BLUE CROSS BLUE SHIELD | AL |