Provider Demographics
NPI:1962557181
Name:VITAL SMILES ALABAMA, P.C.
Entity type:Organization
Organization Name:VITAL SMILES ALABAMA, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COMPTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-271-6851
Mailing Address - Street 1:1900 CRESTWOOD BLVD
Mailing Address - Street 2:STE 211
Mailing Address - City:IRONDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35210-2034
Mailing Address - Country:US
Mailing Address - Phone:205-271-6851
Mailing Address - Fax:
Practice Address - Street 1:3700 BLUE SPRING RD NW
Practice Address - Street 2:STE F
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35810-3479
Practice Address - Country:US
Practice Address - Phone:256-852-9994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty