Organization
SOUTHLAKE DENTAL CARE MANAGEMENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KAROL MEDINA POCZATEK D.M.D. (DENTIST)
(205) 988-5656
Entity
Organization
Contact information
Practice address
4501 SOUTHLAKE PKWY, HOOVER, AL 35244-3644
(205) 988-5656
(205) 988-3972
Mailing address
4501 SOUTHLAKE PKWY, HOOVER, AL 35244-3644
(205) 988-5656
(205) 988-3972
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
3410
AL
122300000X
Dentist
4159
AL
122300000X
Dentist
51171
AL
122300000X
Dentist
5257
AL
122300000X
Dentist
5423
AL
122300000X
Dentist
Primary
5772
AL
122300000X
Dentist
6258
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
126341
—
AL
Enumeration date
04/18/2016
Last updated
04/18/2016
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