Organization
FRESH WAVE DENTAL CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DEBBIELEE J HAWN (OFFICE MANGER)
(334) 347-9283
Entity
Organization
Contact information
Practice address
812 BOLL WEEVIL CIR, ENTERPRISE, AL 36330-2079
(334) 347-9283
Mailing address
812 BOLL WEEVIL CIR, ENTERPRISE, AL 36330-2079
(334) 347-9283
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
4810
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51027316
BLUE CROSS BLUE SHIELD
AL
Enumeration date
04/08/2008
Last updated
04/08/2008
Update your record
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