Organization
SOUTHSIDE FAMILY & COSMETIC DENTISTRY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONNA JENNINGS (OFFICE MANAGER)
(256) 442-1463
Entity
Organization
Contact information
Practice address
1745 HIGHWAY 77, SOUTHSIDE, AL 35907-0169
(256) 442-1463
(256) 442-9821
Mailing address
1745 HIGHWAY 77, SOUTHSIDE, AL 35907-0169
(256) 442-1463
(256) 442-9821
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
124Q00000X
Dental Hygienist
—
—
126800000X
Dental Assistant
—
—
Other
Enumeration date
03/27/2013
Last updated
03/27/2013
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