Provider Demographics
NPI:1114390325
Name:CHILDREN'S DENTISTRY OF ALABAMA
Entity Type:Organization
Organization Name:CHILDREN'S DENTISTRY OF ALABAMA
Other - Org Name:OAK MOUNTAIN PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:HARRIS
Authorized Official - Last Name:FLANNERY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:205-613-6475
Mailing Address - Street 1:6930 CAHABA VALLEY RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-2672
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6930 CAHABA VALLEY RD
Practice Address - Street 2:SUITE 200
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-2672
Practice Address - Country:US
Practice Address - Phone:205-613-6475
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-10
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL60491223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty