Organization
CRESTLINE VILLAGE DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GEORGIA C JONES D.M.D. (OWNER)
(205) 870-5700
Entity
Organization
Contact information
Practice address
244 COUNTRY CLUB PARK, BIRMINGHAM, AL 35213-4200
(205) 870-5700
(205) 870-5699
Mailing address
244 COUNTRY CLUB PARK, BIRMINGHAM, AL 35213-4200
(205) 870-5700
(205) 870-5699
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
5014
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5014
ALABAMA DENTAL LICENSE NU
AL
Enumeration date
07/30/2007
Last updated
07/30/2007
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