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Organization
DENTAL ASSOCIATES OF MADISON, LLC
Active
Organization
DENTAL ASSOCIATES OF MADISON, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TERRI WRENN (ADMINISTRATIVE ASSISTANT)
(256) 772-9988
Entity
Organization
Contact information
Practice address
4072 SULLIVAN ST, SUITE A, MADISON, AL 35758-3152
(256) 772-9988
(256) 772-9991
Mailing address
4072 SULLIVAN ST, SUITE A, MADISON, AL 35758-3152
(256) 772-9988
(256) 772-9991
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
4231
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000091741
—
AL
01
—
51091741
BCBS AL
AL
Enumeration date
03/25/2009
Last updated
03/25/2009
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