Provider Demographics
NPI:1861966475
Name:DENTAL ASSOCIATES OF CHILDERSBURG LLC
Entity type:Organization
Organization Name:DENTAL ASSOCIATES OF CHILDERSBURG LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:256-353-5600
Mailing Address - Street 1:34011B US HIGHWAY 280
Mailing Address - Street 2:
Mailing Address - City:CHILDERSBURG
Mailing Address - State:AL
Mailing Address - Zip Code:35044-2128
Mailing Address - Country:US
Mailing Address - Phone:256-378-3127
Mailing Address - Fax:
Practice Address - Street 1:34011B US HIGHWAY 280
Practice Address - Street 2:
Practice Address - City:CHILDERSBURG
Practice Address - State:AL
Practice Address - Zip Code:35044-2128
Practice Address - Country:US
Practice Address - Phone:256-378-3127
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty