# UNIVERSITY OF ALABAMA AT BIRMINGHAM

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1144660945
- **Authorized official:** DR. JANICE G. JACKSON D.M.D. (PEDIATRIC DENTISTRY PROGRAM DIRECTO)
- **Authorized official phone:** (205) 934-1134

## Contact information

- **Practice address:** 1919 7TH AVE S, SDB ROOM 311, BIRMINGHAM, AL 35294-0007
- **Practice address phone:** (205) 934-7016
- **Mailing address:** 1919 7TH AVE S, SDB ROOM 311, BIRMINGHAM, AL 35233-2005
- **Mailing address phone:** (205) 934-7016

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | — | NULL | Yes |
| 1223P0221X | Pediatric Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 06/26/2013
- **Last updated:** 06/26/2013