MEDICARE: ADVANTAGE DENTAL ORAL HEALTH AND VISION CENTER OF ALABAMA, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

General Provider Information

NPI Number	:	1205312378
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANTAGE DENTAL ORAL HEALTH AND VISION CENTER OF ALABAMA, P.C.

Provider Business Mailing Address
First Line	:	PO BOX 411714
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02241-6805
Country	:	US
Telephone Number	:	629-999-5014
Fax Number	:

Provider Business Practice Location Address
First Line	:	1572 MILL SQ
Second Line	:
City	:	ALEXANDER CITY
State	:	AL
Zip	:	35010-2674
Country	:	US
Telephone Number	:	256-397-1050
Fax Number	:	256-397-1051

Authorized Official
Title or Position	:	MANAGER, LICENSING & CREDENTIALING
Name	:	SHERRIE EDMONDSON
Credential	:
Telephone Number	:	629-999-5014

Provider Enumeration Date	:	07/12/2018
Last Update Date	:	03/04/2024

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