Provider Demographics
NPI:1194155333
Name:DENTAL ASSOCIATES OF FYFFE, LLC
Entity type:Organization
Organization Name:DENTAL ASSOCIATES OF FYFFE, 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:G
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:256-353-5600
Mailing Address - Street 1:1516 MAIN ST
Mailing Address - Street 2:P.O. BOX 128
Mailing Address - City:FYFFE
Mailing Address - State:AL
Mailing Address - Zip Code:35971-3484
Mailing Address - Country:US
Mailing Address - Phone:256-623-2272
Mailing Address - Fax:256-623-2274
Practice Address - Street 1:1516 MAIN ST
Practice Address - Street 2:
Practice Address - City:FYFFE
Practice Address - State:AL
Practice Address - Zip Code:35971-3484
Practice Address - Country:US
Practice Address - Phone:256-623-2272
Practice Address - Fax:256-623-2274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-26
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty