Provider Demographics
NPI:1053740134
Name:DENTON DENTAL OF MILLBROOK PC
Entity type:Organization
Organization Name:DENTON DENTAL OF MILLBROOK PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DENTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-580-0979
Mailing Address - Street 1:PO BOX 1236
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36533-1236
Mailing Address - Country:US
Mailing Address - Phone:251-580-0979
Mailing Address - Fax:
Practice Address - Street 1:720 MONUMENT DR
Practice Address - Street 2:
Practice Address - City:MILLBROOK
Practice Address - State:AL
Practice Address - Zip Code:36054-1849
Practice Address - Country:US
Practice Address - Phone:334-285-3797
Practice Address - Fax:334-285-8900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-08
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL45021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty