Provider Demographics
NPI:1467663401
Name:SOUTHSIDE FAMILY DENTISTRY, INC.
Entity type:Organization
Organization Name:SOUTHSIDE FAMILY DENTISTRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KUNTAL
Authorized Official - Middle Name:S
Authorized Official - Last Name:PANDIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-251-6928
Mailing Address - Street 1:1715 11TH AVE S STE C
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-4704
Mailing Address - Country:US
Mailing Address - Phone:205-251-6928
Mailing Address - Fax:205-251-6968
Practice Address - Street 1:1715 11TH AVE S STE C
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-4704
Practice Address - Country:US
Practice Address - Phone:205-251-6928
Practice Address - Fax:205-251-6968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty