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General NPI Number Information
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NPI Number | 1982978490
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Entity Type | Organization
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Legal Business Name | ADVANTAGE DENTAL ORAL HEALTH AND VISION CENTER OF ALABAMA, P.C.
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Dates
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Enumeration Date | 03/01/2012
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Last Update Date | 12/30/2021
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Provider Practice Location Address
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Address Line | 1911 SKYLAND BLVD E SUITE A3
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City | TUSCALOOSA
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State | AL
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Zip | 35405
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Country | US
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Telephone | 205-469-0444
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Fax | 205-469-0433
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Provider Business Mailing Address
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Address Line | 3322 W END AVE STE 400
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City | NASHVILLE
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State | TN
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Zip | 37203-6805
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Country | US
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Telephone | 629-999-5014
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Fax |
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Authorized Official
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Title or Position | MANAGER, LICENSING & CREDENTIALING
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Name | SHERRIE EDMONDSON
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Credential |
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Telephone | 629-999-5014
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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