Organization
CHILDREN AND TEEN DENTAL GROUP OF ALABAMA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN SMITH (CFO)
(770) 231-5348
Entity
Organization
Contact information
Practice address
221 RICE MINE RD NE STE A, TUSCALOOSA, AL 35406-2401
(205) 758-3341
Mailing address
2300 LAKEVIEW PKWY STE 250, ALPHARETTA, GA 30009-3954
(470) 207-3264
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
Other
Enumeration date
02/02/2016
Last updated
01/21/2025
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