NPIMap

Organization Active NPI

Advantage Dental Oral Health and Vision Center of Alabama, P.C.

  • General Practice Dentistry
  • Enterprise, AL
National Provider Identifier
1114186699
Registry record updated Mar 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
ADVANTAGE DENTAL ORAL HEALTH AND VISION CENTER OF ALABAMA, P.C.
Practice address
1100 Rucker Blvd Ste a-1
Enterprise, AL 36330-3623
Phone
(334) 347-5550
Fax
(334) 347-5551
NPI assigned
Jun 9, 2008
Last updated
Mar 4, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2024

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

Authorized official

Name
Sherrie Edmondson
Title
Sr Manager, L& C
Phone
(629) 999-5014

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X Primary
Pediatric Dentistry 1223P0221X AL

Addresses

Primary practice location

1100 Rucker Blvd Ste a-1
Enterprise, AL 36330-3623

Mailing address

PO Box 411714
Boston, MA 02241-6805
Phone (629) 999-5014

Other identifiers 2

IdentifierTypeStateIssuer
3633798OtherALUNITED CONCORDIA
102590MedicaidAL

National Provider Directory

National Provider Directory
Tax ID family
Advantage Dental Oral Health and Vision Center of Alabama PC31 organizations share this tax ID, including this one

Other organizations with this tax ID 30

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

View all 30

Locations

1100 Rucker Blvd
Ste A1
Enterprise, AL 36330
Phone (334) 347-5550

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": "1212969600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709510400000",
    "number": "1114186699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 411714",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022416805",
            "telephone_number": "629-999-5014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 RUCKER BLVD STE A-1",
            "city": "ENTERPRISE",
            "state": "AL",
            "postal_code": "363303623",
            "telephone_number": "334-347-5550",
            "fax_number": "334-347-5551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANTAGE DENTAL ORAL HEALTH AND VISION CENTER OF ALABAMA, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-09",
        "last_updated": "2024-03-04",
        "certification_date": "2024-03-04",
        "status": "A",
        "authorized_official_last_name": "EDMONDSON",
        "authorized_official_first_name": "SHERRIE",
        "authorized_official_title_or_position": "SR MANAGER, L& C",
        "authorized_official_telephone_number": "629-999-5014"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "AL",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "3633798",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102590",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Enterprise, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2024; 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.