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Organization
PEDIATRIC AND ADOLESCENT DENTISTRY, LLC
Active
Organization
PEDIATRIC AND ADOLESCENT DENTISTRY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM CLARK THOMAS DMD (PRESIDENT)
(205) 982-0112
Entity
Organization
Contact information
Practice address
5346 STADIUM TRACE PKWY, SUITE 108, BIRMINGHAM, AL 35244-4582
(205) 982-0112
(205) 982-0737
Mailing address
5346 STADIUM TRACE PKWY, SUITE 108, BIRMINGHAM, AL 35244-4582
(205) 982-0112
(205) 982-0737
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
5122
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51540792
BC/BS
AL
Enumeration date
08/30/2007
Last updated
08/30/2007
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