| Organization Name: | SCOTTSBORO FAMILY AND GENERAL DENTISTRY PC |
| NPI Number: | 1083069579 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BARRETT L BRADFORD (PRESIDENT) |
| Mailing Address: | 420 S Market St Scottsboro |
| State: | AL US |
| Postal Code: | 357681857 |
| Phone Number: | 2562594411 |
| Fax Number: | 2565745653 |
| NPI Enumeration Date: | 05/03/2016 |
| NPI Last Update Date: | 05/03/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | D6098 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AL |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |