Provider Demographics
NPI:1548698004
Name:DENTAL ASSOCIATES OF EAST MONTGOMERY
Entity type:Organization
Organization Name:DENTAL ASSOCIATES OF EAST MONTGOMERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BILLY
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:FOXWORTH
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:334-272-1677
Mailing Address - Street 1:210 WINTON M BLOUNT LOOP
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-3501
Mailing Address - Country:US
Mailing Address - Phone:334-272-1677
Mailing Address - Fax:334-272-8385
Practice Address - Street 1:210 WINTON M BLOUNT LOOP
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-3501
Practice Address - Country:US
Practice Address - Phone:334-272-1677
Practice Address - Fax:334-272-8385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-21
Last Update Date:2013-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL23411223G0001X
AL43741223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty