| Southern Roots Family And Cosmetic Dentistry | |
|
6154 Omni Park Dr Mobile AL 36609-5195 | |
| (251) 414-5142 | |
| Not Available |
| Full Name | Southern Roots Family And Cosmetic Dentistry |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 6154 Omni Park Dr, Mobile, Alabama |
| Authorized Official Name and Position | Walter P Vickers (OWNER) |
| Authorized Official Contact | 2513420380 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Roots Family And Cosmetic Dentistry 6154 Omni Park Dr Mobile AL 36609-5195 Ph: (251) 414-5142 | Southern Roots Family And Cosmetic Dentistry 6154 Omni Park Dr Mobile AL 36609-5195 Ph: (251) 414-5142 |
| NPI Number | 1336973999 |
|---|---|
| Provider Enumeration Date | 08/27/2024 |
| Last Update Date | 09/18/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336973999 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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