Organization
DOTHAN SMILES YOUTH DENTISTRY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JENELL STUMP (MANAGER - LICENSING & CREDENTIALING)
(615) 750-0343
Entity
Organization
Contact information
Practice address
5412 MONTGOMERY HWY, SUITE 8, DOTHAN, AL 36303-1657
(334) 983-1730
(334) 983-1725
Mailing address
16 ARCADE UNIT 198747, NASHVILLE, TN 37219-1994
(615) 750-0343
(615) 986-1705
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
529932450
—
AL
Enumeration date
04/19/2007
Last updated
07/09/2014
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