Healthcare Provider Details

I. General information

NPI: 1285573576
Provider Name (Legal Business Name): MOUNTAIN SMILES - ADVANCED ENDODONTICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 20TH ST S
BIRMINGHAM AL
35205-4916
US

IV. Provider business mailing address

1500 20TH ST S
BIRMINGHAM AL
35205-4916
US

V. Phone/Fax

Practice location:
  • Phone: 205-933-8544
  • Fax:
Mailing address:
  • Phone: 205-933-8544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANGEL GIMENEZ
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 719-300-5933