Provider Demographics
NPI:1265009203
Name:AL DENTAL GROUP L.L.C.
Entity Type:Organization
Organization Name:AL DENTAL GROUP L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KHALED
Authorized Official - Middle Name:
Authorized Official - Last Name:ALMANSOOB
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:205-447-9479
Mailing Address - Street 1:2500 CENTER POINT PKWY
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35215-2552
Mailing Address - Country:US
Mailing Address - Phone:205-854-7448
Mailing Address - Fax:
Practice Address - Street 1:2500 CENTER POINT PKWY
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35215-2552
Practice Address - Country:US
Practice Address - Phone:205-854-7448
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental