Organization
TRUSSVILLE PEDIATRIC DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS G WILLINGHAM DMD (OWNER)
(205) 655-1000
Entity
Organization
Contact information
Practice address
123 N CHALKVILLE RD, STE 1, TRUSSVILLE, AL 35173-1376
(205) 655-1000
(205) 655-7196
Mailing address
123 N CHALKVILLE RD, STE 1, TRUSSVILLE, AL 35173-1376
(205) 655-1000
(205) 655-7196
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
5379
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
559929290
—
AL
Enumeration date
11/27/2007
Last updated
11/19/2009
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