Organization
ADVANTAGE DENTAL ORAL HEALTH AND VISION CENTER OF ALABAMA, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHERRIE EDMONDSON (MANAGER, LICENSING & CREDENTIALING)
(629) 999-5014
Entity
Organization
Contact information
Practice address
1810 STADIUM DR, SUITE 120, PHENIX CITY, AL 36867-3177
(334) 480-4004
(334) 480-4040
Mailing address
230 E 10TH ST, SUITE 106, ANNISTON, AL 36207-5771
(256) 741-7340
(256) 741-7373
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
180917
—
AL
Enumeration date
12/01/2015
Last updated
12/30/2021
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