Provider Demographics
NPI:1730725045
Name:SATSUMA FAMILY DENTAL PC
Entity type:Organization
Organization Name:SATSUMA FAMILY DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:TEDDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-679-9428
Mailing Address - Street 1:5651 HIGHWAY 43
Mailing Address - Street 2:
Mailing Address - City:SATSUMA
Mailing Address - State:AL
Mailing Address - Zip Code:36572-2115
Mailing Address - Country:US
Mailing Address - Phone:251-679-9428
Mailing Address - Fax:
Practice Address - Street 1:5651 HIGHWAY 43
Practice Address - Street 2:
Practice Address - City:SATSUMA
Practice Address - State:AL
Practice Address - Zip Code:36572-2115
Practice Address - Country:US
Practice Address - Phone:251-679-9428
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-21
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment