# ADVANTAGE DENTAL ORAL HEALTH AND VISION CENTER OF ALABAMA, P.C.

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

## Provider details

- **NPI number:** 1194030387
- **Authorized official:** SHERRIE EDMONDSON (MANAGER, LICENSING & CREDENTIALING)
- **Authorized official phone:** (629) 999-5014

## Contact information

- **Practice address:** 1141 JASPER DENNIS RD, CLANTON, AL 35045-3783
- **Practice address phone:** (205) 312-0001
- **Practice address fax:** (205) 312-0002
- **Mailing address:** PO BOX 411714, BOSTON, MA 02241-6805
- **Mailing address phone:** (629) 999-5014

## Taxonomy

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

## Other

- **Enumeration date:** 08/11/2010
- **Last updated:** 03/04/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 121795 | — | AL |