Individual
HOLTON DEATHERAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1919 7TH AVE S, BIRMINGHAM, AL 35233-2005
(205) 934-4507
Mailing address
1919 7TH AVE S, BIRMINGHAM, AL 35233-2005
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D-0007102-C1
AL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/27/2021
Last updated
11/11/2022
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