Provider Demographics
NPI:1386916682
Name:CUSTOM DENTURES P.C.
Entity type:Organization
Organization Name:CUSTOM DENTURES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:D
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-428-0007
Mailing Address - Street 1:4817 MCADORY SCHOOL RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MC CALLA
Mailing Address - State:AL
Mailing Address - Zip Code:35111-3452
Mailing Address - Country:US
Mailing Address - Phone:205-428-0007
Mailing Address - Fax:205-428-0085
Practice Address - Street 1:4817 MCADORY SCHOOL ROAD
Practice Address - Street 2:SUITE 105
Practice Address - City:MCCALLA
Practice Address - State:AL
Practice Address - Zip Code:35111-3452
Practice Address - Country:US
Practice Address - Phone:205-428-0007
Practice Address - Fax:205-428-0085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5554122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty