Provider Demographics
NPI:1538590864
Name:R.DAVID RODEN, JR.,DMD,MD,PC
Entity type:Organization
Organization Name:R.DAVID RODEN, JR.,DMD,MD,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:RODEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD, MD
Authorized Official - Phone:205-870-5834
Mailing Address - Street 1:1771 INDEPENDENCE CT
Mailing Address - Street 2:SUITE 2
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35216-1258
Mailing Address - Country:US
Mailing Address - Phone:205-870-5834
Mailing Address - Fax:205-870-1618
Practice Address - Street 1:1771 INDEPENDENCE CT
Practice Address - Street 2:SUITE 2
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35216-1258
Practice Address - Country:US
Practice Address - Phone:205-870-5834
Practice Address - Fax:205-870-1618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL52281223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty