Organization
HERITAGE DENTAL GROUP USA.LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SHYRL L JOHNSON (OFFICE MANAGER)
(251) 639-0911
Entity
Organization
Contact information
Practice address
740 HILLCREST RD STE 2B, MOBILE, AL 36695-4021
(251) 639-0911
(251) 633-7889
Mailing address
740 HILLCREST RD STE 2B, MOBILE, AL 36695-4021
(251) 639-0911
(251) 633-7889
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
4049
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
165097
—
AL
Enumeration date
01/12/2016
Last updated
01/12/2016
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