Provider Demographics
NPI:1801934815
Name:GREAT EXPRESSIONS DENTAL CARE
Entity type:Organization
Organization Name:GREAT EXPRESSIONS DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BATTLE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:256-859-0902
Mailing Address - Street 1:PO BOX 1777
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:AL
Mailing Address - Zip Code:35762-1777
Mailing Address - Country:US
Mailing Address - Phone:256-859-0902
Mailing Address - Fax:256-859-0012
Practice Address - Street 1:5045 NORTH MEMORIAL PARKWAY
Practice Address - Street 2:STE D
Practice Address - City:HUNSTVILLE
Practice Address - State:AL
Practice Address - Zip Code:35810
Practice Address - Country:US
Practice Address - Phone:256-859-0902
Practice Address - Fax:256-859-0012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL53121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty