| Pediatric And Adolescent Dentistry, Llc | |
|
5346 Stadium Trace Pkwy Suite 108 Birmingham AL 35244-4582 | |
| (205) 982-0112 | |
| (205) 982-0737 |
| Full Name | Pediatric And Adolescent Dentistry, Llc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 5346 Stadium Trace Pkwy, Birmingham, Alabama |
| Authorized Official Name and Position | William Clark Thomas (PRESIDENT) |
| Authorized Official Contact | 2059820112 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pediatric And Adolescent Dentistry, Llc 5346 Stadium Trace Pkwy Suite 108 Birmingham AL 35244-4582 Ph: (205) 982-0112 | Pediatric And Adolescent Dentistry, Llc 5346 Stadium Trace Pkwy Suite 108 Birmingham AL 35244-4582 Ph: (205) 982-0112 |
| NPI Number | 1851585079 |
|---|---|
| Provider Enumeration Date | 08/30/2007 |
| Last Update Date | 08/30/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851585079 | NPI | - | NPPES |
| 51540792 | Other | AL | BC/BS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 5122 (Alabama) | Primary |
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