Dental Care Clinic Profile
| Full Name | |
|---|
| Speciality | Clinic/Center |
|---|
| Location | 140 Front Street, Gilbertown, Alabama |
|---|
| Authorized Official Name and Position | Charles White (CHIEF EXECUTIVE OFFICER) |
|---|
| Authorized Official Contact | 2514324117 |
|---|
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
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Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Po Box 2048
Mobile
AL 36652-2048
Ph: (251) 434-8177 |
140 Front Street
Suite 4
Gilbertown
AL 36908
Ph: (251) 843-5537 |
NPI Details:
| NPI Number | 1093775918 |
|---|
| Provider Enumeration Date | 03/24/2006 |
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| Last Update Date | 08/30/2022 |
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Medicare PECOS Information:
| Medicare PECOS PAC ID | 1658356308 |
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| Medicare Enrollment ID | O20100729000972 |
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Medical Identifiers
Medical identifiers for
such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1093775918 | NPI | - | NPPES |
| Q727 | Other | AL | BCBS |
| 630011014 | Medicaid | AL | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 122300000X | Dentist | (* (Not Available)) | Secondary |
| 124Q00000X | Dental Hygienist | (* (Not Available)) | Secondary |
| 126800000X | Dental Assistant | (* (Not Available)) | Secondary |
| 152W00000X | Optometrist | (* (Not Available)) | Secondary |
| 152WL0500X | Optometrist - Low Vision Rehabilitation | (* (Not Available)) | Secondary |
| 152WP0200X | Optometrist - Pediatrics | (* (Not Available)) | Secondary |
| 152WS0006X | Optometrist - Sports Vision | (* (Not Available)) | Secondary |
| 152WV0400X | Optometrist - Vision Therapy | (* (Not Available)) | Secondary |
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 207QA0505X | Family Medicine - Adult Medicine | (* (Not Available)) | Secondary |
| 207QG0300X | Family Medicine - Geriatric Medicine | (* (Not Available)) | Secondary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Reviews and Comments