Organization
SOUTH ALABAMA PEDIATRIC DENTISTRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EARL GAINES THOMAS D.M.D (OWNER)
(251) 345-1717
Entity
Organization
Contact information
Practice address
801 UNIVERSITY BLVD S, STE B, MOBILE, AL 36609-2923
(251) 345-1717
(251) 343-0835
Mailing address
801 UNIVERSITY BLVD S, STE B, MOBILE, AL 36609-2923
(251) 345-1717
(251) 343-0835
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
3282
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
529912670
—
AL
Enumeration date
03/07/2007
Last updated
12/31/2013
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