Provider Demographics
NPI:1568440469
Name:DOUBLE OAK MOUNTAIN FAMILY DENTISTRY, LLC
Entity Type:Organization
Organization Name:DOUBLE OAK MOUNTAIN FAMILY DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:H.
Authorized Official - Middle Name:GRADY
Authorized Official - Last Name:SWICORD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-991-8850
Mailing Address - Street 1:5510 HIGHWAY 280
Mailing Address - Street 2:SUITE 104-105
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-6582
Mailing Address - Country:US
Mailing Address - Phone:205-991-8850
Mailing Address - Fax:205-991-8656
Practice Address - Street 1:5510 HIGHWAY 280
Practice Address - Street 2:SUITE 104-105
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-6582
Practice Address - Country:US
Practice Address - Phone:205-991-8850
Practice Address - Fax:205-991-8656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL40511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty