Organization
CENTER FOR COSMETIC AND RESTORATIVE DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARY KAY CARVER (FINANCIAL COORDINATOR)
(205) 339-6762
Entity
Organization
Contact information
Practice address
2820 LURLEEN B WALLACE BLVD, NORTHPORT, AL 35476-3249
(205) 339-6762
(205) 339-9103
Mailing address
2820 LURLEEN B WALLACE BLVD, NORTHPORT, AL 35476-3249
(205) 339-6762
(205) 339-9103
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4859
AL
1223G0001X
General Practice Dentistry
5007
AL
1223G0001X
General Practice Dentistry
5240
AL
1223G0001X
General Practice Dentistry
5467
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1023199213
INDIVIDUAL NPI
AL
01
—
1356425649
INDIVIDUAL NPI
AL
01
—
1851475149
INDIVIDUAL NPI
AL
01
—
1972679967
INDIVIDUAL NPI
AL
Enumeration date
11/21/2008
Last updated
11/21/2008
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