Healthcare Provider Details

I. General information

NPI: 1891201430
Provider Name (Legal Business Name): SPECIAL CARE DENTAL OF AL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2017
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S PERRY ST
MONTGOMERY AL
36104-4227
US

IV. Provider business mailing address

4350 BROWNSBORO RD STE 210
LOUISVILLE KY
40207-1681
US

V. Phone/Fax

Practice location:
  • Phone: 502-244-2441
  • Fax: 502-254-4069
Mailing address:
  • Phone: 248-528-2116
  • Fax: 502-996-8282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: JOY L STEVENS
Title or Position: VICE PRESIDENT OF RCM
Credential:
Phone: 502-244-2441