NPIMap

Organization Active NPI

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

  • Pediatric Dentistry
  • Phenix City, AL
National Provider Identifier
1225403397
Registry record updated Dec 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
ADVANTAGE DENTAL ORAL HEALTH AND VISION CENTER OF ALABAMA, P.C.
Practice address
1810 Stadium Dr
Suite 120
Phenix City, AL 36867-3177
Phone
(334) 480-4004
Fax
(334) 480-4040
NPI assigned
Dec 1, 2015
Last updated
Dec 30, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2021

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

Authorized official

Name
Sherrie Edmondson
Title
Manager, Licensing & Credentialing
Phone
(629) 999-5014

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X NU Primary

Addresses

Primary practice location

1810 Stadium Dr
Suite 120
Phenix City, AL 36867-3177

Mailing address

230 E 10TH St
Suite 106
Anniston, AL 36207-5771
Phone (256) 741-7340

Other identifiers 1

IdentifierTypeStateIssuer
180917MedicaidAL

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

NPI Registry JSON

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

{
    "created_epoch": "1448928000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640822400000",
    "number": "1225403397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "230 E 10TH ST",
            "address_2": "SUITE 106",
            "city": "ANNISTON",
            "state": "AL",
            "postal_code": "362075771",
            "telephone_number": "256-741-7340",
            "fax_number": "256-741-7373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1810 STADIUM DR",
            "address_2": "SUITE 120",
            "city": "PHENIX CITY",
            "state": "AL",
            "postal_code": "368673177",
            "telephone_number": "334-480-4004",
            "fax_number": "334-480-4040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANTAGE DENTAL ORAL HEALTH AND VISION CENTER OF ALABAMA, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-01",
        "last_updated": "2021-12-30",
        "certification_date": "2021-12-30",
        "status": "A",
        "authorized_official_last_name": "EDMONDSON",
        "authorized_official_first_name": "SHERRIE",
        "authorized_official_title_or_position": "MANAGER, LICENSING & CREDENTIALING",
        "authorized_official_telephone_number": "629-999-5014"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "180917",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phenix City, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2021; 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.