Organization
ADVANTAGE DENTAL ORAL HEALTH AND VISION CENTER OF ALABAMA, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHERRIE EDMONDSON (SR MANAGER, L& C)
(629) 999-5014
Entity
Organization
Contact information
Practice address
1100 RUCKER BLVD STE A-1, ENTERPRISE, AL 36330-3623
(334) 347-5550
(334) 347-5551
Mailing address
PO BOX 411714, BOSTON, MA 02241-6805
(629) 999-5014
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
1223P0221X
Pediatric Dentistry
—
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102590
—
AL
01
—
3633798
UNITED CONCORDIA
AL
Enumeration date
06/09/2008
Last updated
03/04/2024
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