Healthcare Provider Details

I. General information

NPI: 1083535967
Provider Name (Legal Business Name): BIRMINGHAM 25TH DENTAL P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 CENTER POINT PKWY
BIRMINGHAM AL
35215-2548
US

IV. Provider business mailing address

2525 CENTER POINT PKWY
BIRMINGHAM AL
35215-2548
US

V. Phone/Fax

Practice location:
  • Phone: 205-854-8093
  • Fax:
Mailing address:
  • Phone: 205-854-8093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINA CARLSON
Title or Position: CFO
Credential:
Phone: 720-603-4800