Healthcare Provider Details

I. General information

NPI: 1558448068
Provider Name (Legal Business Name): IRONDALE DENTAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1811 2ND AVE N
IRONDALE AL
35210-1107
US

IV. Provider business mailing address

1811 2ND AVE N
IRONDALE AL
35210-1107
US

V. Phone/Fax

Practice location:
  • Phone: 205-956-3810
  • Fax:
Mailing address:
  • Phone: 205-956-3810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2333
License Number StateAL

VIII. Authorized Official

Name: DR. WILLIAM AUBREY CARTER
Title or Position: PRESIDENT
Credential: DDS
Phone: 205-956-3810