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Organization

DENTAL ASSOCIATES OF MADISON, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. TERRI WRENN (ADMINISTRATIVE ASSISTANT)
(256) 772-9988
Entity
Organization

Contact information

Practice address
4072 SULLIVAN ST, SUITE A, MADISON, AL 35758-3152
(256) 772-9988
(256) 772-9991
Mailing address
4072 SULLIVAN ST, SUITE A, MADISON, AL 35758-3152
(256) 772-9988
(256) 772-9991

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
4231
AL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
000091741
AL
01
51091741
BCBS AL
AL
Enumeration date
03/25/2009
Last updated
03/25/2009
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