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General NPI Number Information
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NPI Number | 1285710889
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Entity Type | Organization
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Legal Business Name | DENTAL CARE OF ALABAMA LLC
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Dates
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Enumeration Date | 10/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4500 MONTEVALLO RD SUITE B 105
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City | BIRMINGHAM
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State | AL
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Zip | 35210-3129
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Country | US
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Telephone | 205-595-2273
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Fax | 205-595-2235
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Provider Business Mailing Address
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Address Line | 4500 MONTEVALLO RD SUITE B 105
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City | BIRMINGHAM
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State | AL
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Zip | 35210-3129
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Country | US
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Telephone | 205-595-2273
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Fax | 205-595-2235
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CRAWFORD GLENN BADHAM
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Credential | DMD
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Telephone | 205-595-2273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 3077
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License Number State | AL
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