Healthcare Provider Details

I. General information

NPI: 1205256641
Provider Name (Legal Business Name): CAHABA HEIGHTS PEDIATRIC DENTISTRY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2014
Last Update Date: 04/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4213 DOLLY RIDGE RD
VESTAVIA AL
35243-5703
US

IV. Provider business mailing address

4213 DOLLY RIDGE RD
VESTAVIA AL
35243-5703
US

V. Phone/Fax

Practice location:
  • Phone: 334-354-4027
  • Fax:
Mailing address:
  • Phone: 334-354-4027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: ANDREW RICHARDSON
Title or Position: OWNER
Credential: DDS
Phone: 334-354-4027