# RAINSVILLE PEDIATRIC DENTAL VILLAGE

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

## Provider details

- **NPI number:** 1871976399
- **Authorized official:** DR. TARA L MONCUS DMD (DENTSIT/OWNER)
- **Authorized official phone:** (256) 638-3000

## Contact information

- **Practice address:** 371 MCCURDY AVE S, RAINSVILLE, AL 35986-5215
- **Practice address phone:** (256) 638-3000
- **Practice address fax:** (256) 638-3099
- **Mailing address:** 371 MCCURDY AVE S, RAINSVILLE, AL 35986-5215
- **Mailing address phone:** (256) 638-3000
- **Mailing address fax:** (256) 638-3099

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 6198 | AL | — |
| 1223P0221X | Pediatric Dentistry | 5126 | AL | Yes |

## Other

- **Enumeration date:** 07/01/2015
- **Last updated:** 07/01/2015