MEDICARE: ROSS BRIDGE FAMILY & COSMETIC DENTISTRY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1023247632
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROSS BRIDGE FAMILY & COSMETIC DENTISTRY

Provider Business Mailing Address
First Line	:	2201 GRAND AVE
Second Line	:	SUITE #113
City	:	HOOVER
State	:	AL
Zip	:	35226-6102
Country	:	US
Telephone Number	:	205-945-3035
Fax Number	:

Provider Business Practice Location Address
First Line	:	2201 GRAND AVE
Second Line	:	SUITE #113
City	:	HOOVER
State	:	AL
Zip	:	35226-6102
Country	:	US
Telephone Number	:	205-945-3035
Fax Number	:

Authorized Official
Title or Position	:	PARTNER WITH DR. GIA M. BROTHERS
Name	:	DR. M. JAMIE MOUNT
Credential	:	D.M.D.
Telephone Number	:	205-821-5633

Provider Enumeration Date	:	07/06/2009
Last Update Date	:	07/06/2009

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Directions to “ROSS BRIDGE FAMILY & COSMETIC DENTISTRY ” Practice Location

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