=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316032329
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OAK MOUNTAIN ORTHODONTICS PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2029 OLD MONTGOMERY HIGHWAY
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35244
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-682-7488
-----------------------------------------------------
Fax | 205-682-7487
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2029 OLD MONTGOMERY HIGHWAY
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35244
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-682-7488
-----------------------------------------------------
Fax | 205-682-7487
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT ORTHODONTIST
-----------------------------------------------------
Name | DR. PRISCILLA ARRUDA DENNY
-----------------------------------------------------
Credential | DMD MS
-----------------------------------------------------
Telephone | 205-682-7488
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | 5108
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------