Organization
PINE BELT DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JIMMY C WHITE DMD (GENERAL PARTNER)
(251) 275-3822
Entity
Organization
Contact information
Practice address
297C S JACKSON ST, GROVE HILL, AL 36451-3231
(251) 275-3822
(251) 275-4190
Mailing address
297C S JACKSON ST, P O BOX 129, GROVE HILL, AL 36451-3231
(251) 275-3822
(251) 275-4190
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
AL3287
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1558445999
NATIONAL PROVIDER IDENTIFIER
AL
01
—
1962737916
NATIONAL PROVIDER IDENTIFIER
AL
Enumeration date
04/30/2012
Last updated
04/30/2012
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