Southlake Dental Care Management

Primary specialty

DentistTaxonomy code 122300000X

License

5772 Issued in AL

Legal business name

SOUTHLAKE DENTAL CARE MANAGEMENT

Practice address

4501 Southlake Pkwy
Hoover, AL 35244-3644

Phone

(205) 988-5656

Fax

(205) 988-3972

NPI assigned

Apr 18, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Karol Medina Poczatek, D.M.D.

Title

Dentist

Phone

(205) 988-5656

Specialties & licenses 7

Addresses

Other identifiers 1

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

{
    "created_epoch": "1460937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1460937600000",
    "number": "1124472956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4501 SOUTHLAKE PKWY",
            "city": "HOOVER",
            "state": "AL",
            "postal_code": "352443644",
            "telephone_number": "205-988-5656",
            "fax_number": "205-988-3972"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4501 SOUTHLAKE PKWY",
            "city": "HOOVER",
            "state": "AL",
            "postal_code": "352443644",
            "telephone_number": "205-988-5656",
            "fax_number": "205-988-3972"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHLAKE DENTAL CARE MANAGEMENT",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-18",
        "last_updated": "2016-04-18",
        "status": "A",
        "authorized_official_last_name": "POCZATEK",
        "authorized_official_first_name": "KAROL",
        "authorized_official_middle_name": "MEDINA",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "205-988-5656",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "AL",
            "license": "3410",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "AL",
            "license": "4159",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "AL",
            "license": "5772",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "AL",
            "license": "5257",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "AL",
            "license": "51171",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "AL",
            "license": "6258",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "AL",
            "license": "5423",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "126341",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Southern Medical, Inc.
• Southern Orthopaedic Alliance, PLLC
• Southern Perioperative Services P C
• Southern Smiles
• Elizabeth M. Southern
• Southlake Orthopaedics Dba Southlake Prosthetics & Orthotics
• Southlake Orthopaedics Sports Medicine and Spine Center, PC
• Southlake Orthopaedics Sports Medicine and Spine Center, PC
• Southlake Orthopaedics Sports Medicine and Spine Center, PC
• Victoria Louise Spain, PHARMD

• Dentist in Hoover, AL
• Providers in Hoover, AL by specialty
• Dentist in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2016; 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.