Organization
PEDIATRIC AND ADOLESCENT DENTISTRY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM CLARK THOMAS DMD (PRESIDENT)
(205) 982-0112
Entity
Organization
Contact information
Practice address
5346 STADIUM TRACE PKWY, SUITE 108, BIRMINGHAM, AL 35244-4582
(205) 982-0112
(205) 982-0737
Mailing address
5346 STADIUM TRACE PKWY, SUITE 108, BIRMINGHAM, AL 35244-4582
(205) 982-0112
(205) 982-0737
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
5122
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51540792
BC/BS
AL
Enumeration date
08/30/2007
Last updated
08/30/2007
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