# 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:** 1225403397
- **Authorized official:** SHERRIE EDMONDSON (MANAGER, LICENSING & CREDENTIALING)
- **Authorized official phone:** (629) 999-5014

## Contact information

- **Practice address:** 1810 STADIUM DR, SUITE 120, PHENIX CITY, AL 36867-3177
- **Practice address phone:** (334) 480-4004
- **Practice address fax:** (334) 480-4040
- **Mailing address:** 230 E 10TH ST, SUITE 106, ANNISTON, AL 36207-5771
- **Mailing address phone:** (256) 741-7340
- **Mailing address fax:** (256) 741-7373

## Taxonomy

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

## Other

- **Enumeration date:** 12/01/2015
- **Last updated:** 12/30/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 180917 | — | AL |