NPIMap

Organization Active NPI

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

  • Pediatric Dentistry
  • Athens, AL
National Provider Identifier
1700115201
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
310 W Elm St
Athens, AL 35611-4802
Phone
(256) 262-0200
Fax
(256) 262-0201
NPI assigned
Dec 11, 2009
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 DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X Primary

Addresses

Primary practice location

310 W Elm St
Athens, AL 35611-4802

Mailing address

3322 W End Ave Ste 400
Nashville, TN 37203-6805
Phone (629) 999-5014

Other identifiers 1

IdentifierTypeStateIssuer
115249MedicaidAL

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": "1260489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640822400000",
    "number": "1700115201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3322 W END AVE STE 400",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372036805",
            "telephone_number": "629-999-5014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 W ELM ST",
            "city": "ATHENS",
            "state": "AL",
            "postal_code": "356114802",
            "telephone_number": "256-262-0200",
            "fax_number": "256-262-0201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANTAGE DENTAL ORAL HEALTH AND VISION CENTER OF ALABAMA, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-11",
        "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": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "115249",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Athens, 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.