Provider Demographics
NPI:1154992055
Name:GADSDEN FAMILY DENTISTRY, LLC
Entity type:Organization
Organization Name:GADSDEN FAMILY DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE DEPARTMENT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LASHEA
Authorized Official - Middle Name:
Authorized Official - Last Name:DODSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-647-3181
Mailing Address - Street 1:205 CALDWELL DR
Mailing Address - Street 2:
Mailing Address - City:WARRIOR
Mailing Address - State:AL
Mailing Address - Zip Code:35180-1407
Mailing Address - Country:US
Mailing Address - Phone:205-647-3181
Mailing Address - Fax:205-647-1134
Practice Address - Street 1:1415 RAINBOW DR
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-5319
Practice Address - Country:US
Practice Address - Phone:256-691-0970
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-02
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental