Provider Demographics
NPI:1275770901
Name:CALERA ORTHODONTICS
Entity Type:Organization
Organization Name:CALERA ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SHARE HOLDER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:FERREIRA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD,MS
Authorized Official - Phone:205-910-5595
Mailing Address - Street 1:101 HIGHWAY 87
Mailing Address - Street 2:BLDG 100
Mailing Address - City:CALERA
Mailing Address - State:AL
Mailing Address - Zip Code:35040-7209
Mailing Address - Country:US
Mailing Address - Phone:205-620-4611
Mailing Address - Fax:205-664-4611
Practice Address - Street 1:101 HIGHWAY 87
Practice Address - Street 2:BLDG 100
Practice Address - City:CALERA
Practice Address - State:AL
Practice Address - Zip Code:35040-7209
Practice Address - Country:US
Practice Address - Phone:205-620-4611
Practice Address - Fax:205-664-4611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-16
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL54011223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty