Organization
SAND MOUNTAIN FAMILY DENTISTRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRANT HAYNIE DMD (OWNER/DENTIST)
(205) 467-0387
Entity
Organization
Contact information
Practice address
701 MEDICAL CENTER PKWY, BOAZ, AL 35957-5938
(205) 467-0387
Mailing address
211 DOGWOOD CIR, GADSDEN, AL 35901-5601
(205) 467-0387
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
171653
—
AL
Enumeration date
04/26/2021
Last updated
05/19/2021
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