Provider Demographics
NPI:1215301700
Name:FLINT RIVER DENTISTRY
Entity type:Organization
Organization Name:FLINT RIVER DENTISTRY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:DEERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-859-8066
Mailing Address - Street 1:2246 WINCHESTER RD NE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35811-6800
Mailing Address - Country:US
Mailing Address - Phone:256-859-8066
Mailing Address - Fax:855-259-1075
Practice Address - Street 1:2246 WINCHESTER RD NE
Practice Address - Street 2:SUITE 106
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35811-6800
Practice Address - Country:US
Practice Address - Phone:256-859-8066
Practice Address - Fax:855-259-1075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-20
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5585261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental