Provider Demographics
NPI:1487746871
Name:HOMETOWN FAMILY DENTISTRY, PC
Entity type:Organization
Organization Name:HOMETOWN FAMILY DENTISTRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-836-7276
Mailing Address - Street 1:9133 PARKWAY E
Mailing Address - Street 2:SUITE 101B
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35206
Mailing Address - Country:US
Mailing Address - Phone:205-836-7276
Mailing Address - Fax:
Practice Address - Street 1:9133 PARKWAY E
Practice Address - Street 2:SUITE 101B
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35206
Practice Address - Country:US
Practice Address - Phone:205-836-7276
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4250122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-28675OtherBC/BS PROVIDER NUMBER
AL515-28675OtherBC/BS PROVIDER NUMBER