NPIMap

Organization Active NPI

South Alabama Pediatric Dentistry LLC

  • Pediatric Dentistry
  • Mobile, AL
National Provider Identifier
1437289303
Registry record updated Dec 31, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
3282 Issued in AL
Legal business name
SOUTH ALABAMA PEDIATRIC DENTISTRY LLC
Practice address
801 University Blvd S
Ste B
Mobile, AL 36609-2923
Phone
(251) 345-1717
Fax
(251) 343-0835
NPI assigned
Mar 7, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 31, 2013

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

Authorized official

Name
Dr. Earl Gaines Thomas, D.M.DNPI 1104956069
Title
Owner
Phone
(251) 345-1717

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X 3282 AL Primary

Addresses

Primary practice location

801 University Blvd S
Ste B
Mobile, AL 36609-2923

Mailing address

801 University Blvd S
Ste B
Mobile, AL 36609-2923
Phone (251) 345-1717

Other identifiers 1

IdentifierTypeStateIssuer
529912670MedicaidAL

National Provider Directory

National Provider Directory

Locations

801 S University Blvd
Ste B
Mobile, AL 36609
Phone (251) 343-2170

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1173225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1388448000000",
    "number": "1437289303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 UNIVERSITY BLVD S",
            "address_2": "STE B",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366092923",
            "telephone_number": "251-345-1717",
            "fax_number": "251-343-0835"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 UNIVERSITY BLVD S",
            "address_2": "STE B",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366092923",
            "telephone_number": "251-345-1717",
            "fax_number": "251-343-0835"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH ALABAMA PEDIATRIC DENTISTRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-07",
        "last_updated": "2013-12-31",
        "status": "A",
        "authorized_official_last_name": "THOMAS",
        "authorized_official_first_name": "EARL",
        "authorized_official_middle_name": "GAINES",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "251-345-1717",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "AL",
            "license": "3282",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "529912670",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mobile, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2013; 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.