Healthcare Provider Details

I. General information

NPI: 1366620155
Provider Name (Legal Business Name): BIRMINGHAM PEDIATRIC DENTAL CARE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2008
Last Update Date: 02/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1613 11TH AVE S
BIRMINGHAM AL
35205-4703
US

IV. Provider business mailing address

1613 11TH AVE S
BIRMINGHAM AL
35205-4703
US

V. Phone/Fax

Practice location:
  • Phone: 205-933-1363
  • Fax: 205-933-1365
Mailing address:
  • Phone: 205-933-1363
  • Fax: 205-933-1365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number2693
License Number StateAL

VIII. Authorized Official

Name: DR. FREDERICK B SMITH
Title or Position: PRESIDENT
Credential: DMD
Phone: 205-933-1363