Organization Name: | DIXIELAND DENTAL |
NPI Number: | 1740428937 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MICHAEL CARL PRECISE (OWNER) |
Mailing Address: | 15622 S. Us Hwy 231 Midland City |
State: | AL US |
Postal Code: | 36350 |
Phone Number: | 3349833558 |
Fax Number: | 3349833255 |
NPI Enumeration Date: | 01/27/2009 |
NPI Last Update Date: | 01/27/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | LNO3358 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AL |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |