Provider Demographics
NPI:1154974277
Name:CAMELLIA DENTAL CARE LLC
Entity type:Organization
Organization Name:CAMELLIA DENTAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:205-292-0036
Mailing Address - Street 1:3985 PARKWOOD RD STE 109
Mailing Address - Street 2:#203
Mailing Address - City:BESSEMER
Mailing Address - State:AL
Mailing Address - Zip Code:35022-5691
Mailing Address - Country:US
Mailing Address - Phone:205-292-0036
Mailing Address - Fax:
Practice Address - Street 1:1800 MCFARLAND BLVD N STE 230
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-2179
Practice Address - Country:US
Practice Address - Phone:205-345-1136
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty