Provider Demographics
NPI:1215086251
Name:ASHVILLE FAMILY DENTISTRY, LLC
Entity type:Organization
Organization Name:ASHVILLE FAMILY DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-ASHVILLE FAMILY DENTISTRY
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:BRENT
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-594-5044
Mailing Address - Street 1:PO BOX 129
Mailing Address - Street 2:
Mailing Address - City:ASHVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35953-0129
Mailing Address - Country:US
Mailing Address - Phone:205-594-5044
Mailing Address - Fax:205-594-5388
Practice Address - Street 1:279 5TH AVE
Practice Address - Street 2:
Practice Address - City:ASHVILLE
Practice Address - State:AL
Practice Address - Zip Code:35953
Practice Address - Country:US
Practice Address - Phone:205-594-5044
Practice Address - Fax:205-594-5388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL51921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty