Provider Demographics
NPI:1528443546
Name:PIEDMONT DENTAL GROUP LLC
Entity type:Organization
Organization Name:PIEDMONT DENTAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:EBERHART
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:256-927-2600
Mailing Address - Street 1:114 W LADIGA ST
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:AL
Mailing Address - Zip Code:36272-2018
Mailing Address - Country:US
Mailing Address - Phone:256-447-7844
Mailing Address - Fax:
Practice Address - Street 1:114 W LADIGA ST
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:AL
Practice Address - Zip Code:36272-2018
Practice Address - Country:US
Practice Address - Phone:256-447-7844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-21
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5161122300000X
AL4860122300000X
AL5112122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty