Organization
RAINSVILLE PEDIATRIC DENTAL VILLAGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TARA L MONCUS DMD (DENTSIT/OWNER)
(256) 638-3000
Entity
Organization
Contact information
Practice address
371 MCCURDY AVE S, RAINSVILLE, AL 35986-5215
(256) 638-3000
(256) 638-3099
Mailing address
371 MCCURDY AVE S, RAINSVILLE, AL 35986-5215
(256) 638-3000
(256) 638-3099
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
6198
AL
1223P0221X
Pediatric Dentistry
Primary
5126
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1003811241
—
AL
Enumeration date
07/01/2015
Last updated
07/01/2015
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