1013249242 NPI number — ALABAMA DENTAL PROFESSIONALS, PC

Table of content: (NPI 1013249242)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013249242 NPI number — ALABAMA DENTAL PROFESSIONALS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALABAMA DENTAL PROFESSIONALS, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
VALLEY SMILES DENTAL CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013249242
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/19/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
110 COLLEGE ST.
Provider Second Line Business Mailing Address:
SUITE D
Provider Business Mailing Address City Name:
ATHENS
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35611
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-232-0789
Provider Business Mailing Address Fax Number:
256-232-5247

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 COLLEGE ST.
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
ATHENS
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-232-0789
Provider Business Practice Location Address Fax Number:
256-232-5247
Provider Enumeration Date:
02/14/2010

Additional Information

Authorized Official

Authorized Official Last Name:
WALKER
Authorized Official First Name:
KENDRA
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING COORDINATOR
Authorized Official Telephone Number:
217-540-8312

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  3836 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223G0001X , with the licence number: 5267 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: 4084 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1912092164 . This is a "NPI" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 1437242195 . This is a "NPI" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 1023101524 . This is a "NPI" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 1942570361 . This is a "NPI" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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