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Organization

SOUTHERN ROOTS FAMILY AND COSMETIC DENTISTRY

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. WALTER P VICKERS JR. (OWNER)
(251) 342-0380
Entity
Organization

Contact information

Practice address
6154 OMNI PARK DR, MOBILE, AL 36609-5195
(251) 414-5142
Mailing address
6154 OMNI PARK DR, MOBILE, AL 36609-5195
(251) 414-5142

Taxonomy

Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary

Other

Enumeration date
08/27/2024
Last updated
09/18/2024
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