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Organization
SOUTH ALABAMA PEDIATRIC DENTISTRY LLC
Active
Organization
SOUTH ALABAMA PEDIATRIC DENTISTRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EARL GAINES THOMAS D.M.D (OWNER)
(251) 345-1717
Entity
Organization
Contact information
Practice address
801 UNIVERSITY BLVD S, STE B, MOBILE, AL 36609-2923
(251) 345-1717
(251) 343-0835
Mailing address
801 UNIVERSITY BLVD S, STE B, MOBILE, AL 36609-2923
(251) 345-1717
(251) 343-0835
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
3282
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
529912670
—
AL
Enumeration date
03/07/2007
Last updated
12/31/2013
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