Advantage Dental Oral Health and Vision Center of Alabama, P.C.
Organization Active NPI Pediatric Dentistry · Leesburg, AL
NPI 1003046772 · NPPES record last updated Mar 4, 2024
Key facts
- NPI
- 1003046772
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pediatric Dentistry 1223P0221X
- Legal business name
- ADVANTAGE DENTAL ORAL HEALTH AND VISION CENTER OF ALABAMA, P.C.
- Practice address
- 215C Industrial Blvd
Leesburg, AL 35983-3742 - Phone
- (256) 526-7601
- Fax
- (256) 526-7603
- NPI assigned
- Jul 16, 2009
- Organization subpart
- No
Authorized official
- Name
- Sherrie Edmondson
- Title
- Manager, Licensing & Credentialing
- Phone
- (629) 999-5014
Corporate family (same tax ID) 30
National Provider Directory
- Tax ID family
- Advantage Dental Oral Health and Vision Center of Alabama PC
Locations
215 Industrial Blvd
#C
Leesburg, AL 35983
Phone (256) 526-7601
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry |
1223P0221X | Yes |
Addresses
Primary practice location
215C Industrial Blvd
Leesburg, AL 35983-3742
Mailing address
PO Box 411714
Boston, MA 02241-6805
Phone (629) 999-5014
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 112230 | Medicaid | AL |
Other providers in Leesburg, AL
- Kristie L Burt
- Kynleigh Paytin Chesnut
- Sam Griggs
- Catherine Hardegree
- Healthstat Onsite Clinic Parkdale Leesburg Al
All providers in Leesburg, AL · Pediatric Dentistry in Alabama
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 4, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.