Healthcare Provider Details

I. General information

NPI: 1346046828
Provider Name (Legal Business Name): CALERA ORTHO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2025
Last Update Date: 02/24/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 CR-87 BLDG 100
CALERA AL
35040
US

IV. Provider business mailing address

101 CR-87 BLDG 100
CALERA AL
35040
US

V. Phone/Fax

Practice location:
  • Phone: 205-620-4611
  • Fax:
Mailing address:
  • Phone: 205-620-4611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: KIM DOSS
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 205-222-1430