Organization
FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHEAL L MADDOX D.M.D. (OWNER)
(256) 593-6322
Entity
Organization
Contact information
Practice address
1163 SEAY AVE, BOAZ, AL 35957-6242
(256) 593-6322
(256) 593-2444
Mailing address
1163 SEAY AVE, P.O. BOX 577, BOAZ, AL 35957
(256) 593-6322
(256) 593-2444
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
3781
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
90799
BCBS
AL
Enumeration date
02/21/2008
Last updated
12/16/2014
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