Provider Demographics
NPI:1285124875
Name:ALABAMA TONGUE-TIE CENTER INC.
Entity type:Organization
Organization Name:ALABAMA TONGUE-TIE CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:TURNER
Authorized Official - Last Name:BAXTER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:205-876-3989
Mailing Address - Street 1:2480 PELHAM PKWY
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35124
Mailing Address - Country:US
Mailing Address - Phone:205-419-4333
Mailing Address - Fax:205-419-4320
Practice Address - Street 1:2480 PELHAM PKWY
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:AL
Practice Address - Zip Code:35124
Practice Address - Country:US
Practice Address - Phone:205-419-4333
Practice Address - Fax:205-419-4320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-18
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5946122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty