Individual
SAMUEL E DEATHERAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
110 COLLEGE ST, SUITE D, ATHENS, AL 35611-2714
(256) 232-0789
(256) 232-5247
Mailing address
110 COLLEGE ST, SUITE D, ATHENS, AL 35611-2714
(256) 232-0789
(256) 232-5247
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
5983
AL
Other
Enumeration date
11/15/2006
Last updated
04/17/2013
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