MEDICARE: VITAL SMILES ALABAMA, 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	1223G0001X	General Practice Dentistry		AL

General Provider Information

NPI Number	:	1962557181
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITAL SMILES ALABAMA, P.C.

Provider Business Mailing Address
First Line	:	1900 CRESTWOOD BLVD
Second Line	:	STE 211
City	:	IRONDALE
State	:	AL
Zip	:	35210-2034
Country	:	US
Telephone Number	:	205-271-6851
Fax Number	:

Provider Business Practice Location Address
First Line	:	3700 BLUE SPRING RD NW
Second Line	:	STE F
City	:	HUNTSVILLE
State	:	AL
Zip	:	35810-3479
Country	:	US
Telephone Number	:	256-852-9994
Fax Number	:

Authorized Official
Title or Position	:	COMPTROLLER
Name	:	MELANIE JOHNSON
Credential	:
Telephone Number	:	205-271-6851

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	04/14/2008

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