NPIMap

Organization Active NPI

1917 Dental Clinic

  • Dentist
  • Birmingham, AL
National Provider Identifier
1093452633
Registry record updated May 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
1917 DENTAL CLINIC
Practice address
3220 5TH Ave S # 2022
Birmingham, AL 35222-2309
Phone
(205) 975-9842
NPI assigned
May 16, 2022
Last updated
May 17, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
UNIVERSITY OF ALABAMA AT BIRMINGHAMAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 17, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jacquiselyn Story
Title
Business Office Director
Phone
(205) 934-5088

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X NU Primary

Addresses

Primary practice location

3220 5TH Ave S # 2022
Birmingham, AL 35222-2309

Mailing address

3220 5TH Ave S # 2022
Birmingham, AL 35222-2309
Phone (205) 975-9842

National Provider Directory

National Provider Directory
Tax ID family
Robert T Brown MD48 organizations share this tax ID, including this one
Part of
Robert T Brown MD

Other organizations with this tax ID 47

Organizations that report the same tax identification number in the National Provider Directory.

View all 47

Locations

3220 5th Ave S
#2022
Birmingham, AL 35222
Phone (205) 975-9842

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1652659200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652745600000",
    "number": "1093452633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3220 5TH AVE S # 2022",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352222309",
            "telephone_number": "205-975-9842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3220 5TH AVE S # 2022",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352222309",
            "telephone_number": "205-975-9842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "1917 DENTAL CLINIC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "UNIVERSITY OF ALABAMA AT BIRMINGHAM",
        "enumeration_date": "2022-05-16",
        "last_updated": "2022-05-17",
        "certification_date": "2022-05-17",
        "status": "A",
        "authorized_official_last_name": "STORY",
        "authorized_official_first_name": "JACQUISELYN",
        "authorized_official_title_or_position": "BUSINESS OFFICE DIRECTOR",
        "authorized_official_telephone_number": "205-934-5088"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Birmingham, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.