MEDICARE: BROOKWOOD DENTAL CARE, PC

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	122300000X	Dentist

General Provider Information

NPI Number	:	1629764691
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROOKWOOD DENTAL CARE, PC

Provider Business Mailing Address
First Line	:	2045 BROOKWOOD MEDICAL CTR DR STE 22
Second Line	:
City	:	HOMEWOOD
State	:	AL
Zip	:	35209-6809
Country	:	US
Telephone Number	:	205-870-9871
Fax Number	:

Provider Business Practice Location Address
First Line	:	2045 BROOKWOOD MEDICAL CTR DR STE 22
Second Line	:
City	:	HOMEWOOD
State	:	AL
Zip	:	35209-6809
Country	:	US
Telephone Number	:	205-870-9871
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DMD
Name	:	DR. PAUL VICKERY BARGANIER
Credential	:	DMD
Telephone Number	:	205-870-9871

Provider Enumeration Date	:	04/13/2023
Last Update Date	:	04/13/2023

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