=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528354537
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JULIANA LA ROTA JONES DMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/28/2011
-----------------------------------------------------
Last Update Date | 07/30/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2490 PELHAM PKWY
-----------------------------------------------------
City | PELHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-419-7444
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5176 COLONIAL PARK RD
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35242-3264
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-821-8851
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 5851
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------