Provider Demographics
NPI:1588112007
Name:HARTSELLE FAMILY DENTISTRY, LLC
Entity type:Organization
Organization Name:HARTSELLE FAMILY DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HOLLADAY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:256-773-0800
Mailing Address - Street 1:1511 HIGHWAY 31 SW
Mailing Address - Street 2:SUITE B
Mailing Address - City:HARTSELLE
Mailing Address - State:AL
Mailing Address - Zip Code:35640-2818
Mailing Address - Country:US
Mailing Address - Phone:256-773-0800
Mailing Address - Fax:
Practice Address - Street 1:1511 HIGHWAY 31 SW
Practice Address - Street 2:SUITE B
Practice Address - City:HARTSELLE
Practice Address - State:AL
Practice Address - Zip Code:35640-2818
Practice Address - Country:US
Practice Address - Phone:256-773-0800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-13
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL57731223G0001X
AL59581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty