Organization
PROFESSIONAL LANE DENTAL ASSOCIATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TONY W DOLLAR DMD (DOCTOR)
(334) 792-0997
Entity
Organization
Contact information
Practice address
102 PROFESSIONAL LN, DOTHAN, AL 36303-3874
(334) 792-0997
(334) 702-6896
Mailing address
102 PROFESSIONAL LN, DOTHAN, AL 36303-3874
(334) 792-0997
(334) 702-6896
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
LNO2848
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51091806
BLUE CROSS BLUE SHIELD
AL
Enumeration date
11/19/2007
Last updated
11/19/2007
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