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Organization

DENTISTRY FOR AWESOME KIDS

Active
Organization subpart
No

Provider details

NPI number
Authorized official
LAUTEN JOHNSON (GENERAL DENTIST)
(205) 447-0202
Entity
Organization

Contact information

Practice address
623 8TH AVE W, BIRMINGHAM, AL 35204-3604
(334) 505-0891
Mailing address
623 8TH AVE W, BIRMINGHAM, AL 35204-3604
(334) 505-0891

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1114368800
AL
05
1992970545
AL
Enumeration date
01/23/2017
Last updated
01/23/2017
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