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General NPI Number Information
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NPI Number | 1891633103
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Entity Type | Organization
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Legal Business Name | MOUNTAIN SMILES - MOUNTAIN BROOK DENTAL CARE PLLC
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Dates
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Enumeration Date | 03/25/2026
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Last Update Date | 03/25/2026
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Provider Practice Location Address
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Address Line | 3928 MONTCLAIR RD STE 120
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City | MOUNTAIN BRK
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State | AL
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Zip | 35213-2415
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Country | US
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Telephone | 205-871-2302
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Fax |
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Provider Business Mailing Address
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Address Line | 3928 MONTCLAIR RD STE 120
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City | MOUNTAIN BRK
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State | AL
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Zip | 35213-2415
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Country | US
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Telephone | 205-871-2302
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING SENIOR MANAGER
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Name | ANGEL GIMENEZ
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Credential |
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Telephone | 719-300-5933
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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 |
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License Number State |
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