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1245530161 NPI number — ADVANTAGE DENTAL ORAL HEALTH AND VISION CENTER OF ALABAMA, P.C.

NPI Number: 1245530161
Health Care Provider/Practitioner: ADVANTAGE DENTAL ORAL HEALTH AND VISION CENTER OF ALABAMA, P.C.

Information about “1245530161” NPI (ADVANTAGE DENTAL ORAL HEALTH AND VISION CENTER OF ALABAMA, P.C.) exists in 1245530161 in HTML format HTML  |  1245530161 in plain Text format TXT  |  1245530161 in PDF (Portable Document Format) PDF  |  1245530161 in an XML format XML  formats.

NPI Number : 1245530161 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1245530161",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "ADVANTAGE DENTAL ORAL HEALTH AND VISION CENTER OF ALABAMA, P.C.",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 411714",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BOSTON",
    "MailingAddressStateName": "MA",
    "MailingAddressPostalCode": "02241-6805",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "629-999-5014",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "6662 HIGHWAY 75 STE 114",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PINSON",
    "PracticeLocationAddressStateName": "AL",
    "PracticeLocationAddressPostalCode": "35126-3200",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "205-693-0100",
    "PracticeLocationAddressFaxNumber": "205-693-0101",
    "EnumerationDate": "10/26/2010",
    "LastUpdateDate": "03/04/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "EDMONDSON",
    "AuthorizedOfficialFirstName": "SHERRIE",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "MANAGER, LICENSING & CREDENTIALING",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "629-999-5014",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "1223P0221X",
        "TaxonomyName": "Pediatric Dentistry",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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