MEDICARE: CAHABA HEIGHTS PEDIATRIC DENTISTRY, P.C.

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	122300000X	Dentist

General Provider Information

NPI Number	:	1205256641
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAHABA HEIGHTS PEDIATRIC DENTISTRY, P.C.

Provider Business Mailing Address
First Line	:	4213 DOLLY RIDGE RD
Second Line	:
City	:	VESTAVIA
State	:	AL
Zip	:	35243-5703
Country	:	US
Telephone Number	:	334-354-4027
Fax Number	:

Provider Business Practice Location Address
First Line	:	4213 DOLLY RIDGE RD
Second Line	:
City	:	VESTAVIA
State	:	AL
Zip	:	35243-5703
Country	:	US
Telephone Number	:	334-354-4027
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANDREW RICHARDSON
Credential	:	DDS
Telephone Number	:	334-354-4027

Provider Enumeration Date	:	04/24/2014
Last Update Date	:	04/24/2014

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