Organization
MOUNTAIN SMILES - PRATTVILLE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGEL GIMENEZ (CREDENTIALING SENIOR MANAGER)
(719) 300-5933
Entity
Organization
Contact information
Practice address
711 KORNEGAY DR STE A, PRATTVILLE, AL 36066-7715
(334) 285-7111
Mailing address
711 KORNEGAY DR STE A, PRATTVILLE, AL 36066-7715
(334) 285-7111
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
03/25/2026
Last updated
03/25/2026
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