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General NPI Number Information
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NPI Number | 1225403397
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Entity Type | Organization
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Legal Business Name | ADVANTAGE DENTAL ORAL HEALTH AND VISION CENTER OF ALABAMA, P.C.
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Dates
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Enumeration Date | 12/01/2015
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Last Update Date | 12/30/2021
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Provider Practice Location Address
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Address Line | 1810 STADIUM DR SUITE 120
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City | PHENIX CITY
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State | AL
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Zip | 36867-3177
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Country | US
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Telephone | 334-480-4004
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Fax | 334-480-4040
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Provider Business Mailing Address
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Address Line | 230 E 10TH ST SUITE 106
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City | ANNISTON
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State | AL
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Zip | 36207-5771
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Country | US
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Telephone | 256-741-7340
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Fax | 256-741-7373
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Authorized Official
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Title or Position | MANAGER, LICENSING & CREDENTIALING
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Name | SHERRIE EDMONDSON
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Credential |
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Telephone | 629-999-5014
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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