# PEDIATRIC AND ADOLESCENT DENTISTRY, LLC

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

## Provider details

- **NPI number:** 1851585079
- **Authorized official:** DR. WILLIAM CLARK THOMAS DMD (PRESIDENT)
- **Authorized official phone:** (205) 982-0112

## Contact information

- **Practice address:** 5346 STADIUM TRACE PKWY, SUITE 108, BIRMINGHAM, AL 35244-4582
- **Practice address phone:** (205) 982-0112
- **Practice address fax:** (205) 982-0737
- **Mailing address:** 5346 STADIUM TRACE PKWY, SUITE 108, BIRMINGHAM, AL 35244-4582
- **Mailing address phone:** (205) 982-0112
- **Mailing address fax:** (205) 982-0737

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | 5122 | AL | Yes |

## Other

- **Enumeration date:** 08/30/2007
- **Last updated:** 08/30/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 51540792 | BC/BS | AL |