Healthcare Provider Details

I. General information

NPI: 1538590864
Provider Name (Legal Business Name): R.DAVID RODEN, JR.,DMD,MD,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2013
Last Update Date: 12/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1771 INDEPENDENCE CT SUITE 2
VESTAVIA AL
35216-1258
US

IV. Provider business mailing address

1771 INDEPENDENCE CT SUITE 2
VESTAVIA AL
35216-1258
US

V. Phone/Fax

Practice location:
  • Phone: 205-870-5834
  • Fax: 205-870-1618
Mailing address:
  • Phone: 205-870-5834
  • Fax: 205-870-1618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number5228
License Number StateAL

VIII. Authorized Official

Name: DR. RALPH DAVID RODEN JR.
Title or Position: PRESIDENT
Credential: DMD, MD
Phone: 205-870-5834