Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 2637 | AL |
NPI | 1023177078 |
---|---|
Provider Name | Dr. Grady L. Price JR. |
First Address | Montgomery, AL 36106-3600 |
Second Address | Montgomery, AL 36106-3600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2637 | BOARD OF DENTAL EXAMINERS (01) | AL |