Provider Demographics
NPI:1972692242
Name:PARVIN, AMY T (D M D)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:T
Last Name:PARVIN
Suffix:
Gender:F
Credentials:D M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 SHARIT AVE
Mailing Address - Street 2:SUITE 113
Mailing Address - City:GARDENDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35071-5000
Mailing Address - Country:US
Mailing Address - Phone:205-631-2240
Mailing Address - Fax:205-631-1611
Practice Address - Street 1:925 SHARIT AVE
Practice Address - Street 2:SUITE 113
Practice Address - City:GARDENDALE
Practice Address - State:AL
Practice Address - Zip Code:35071-5000
Practice Address - Country:US
Practice Address - Phone:205-631-2240
Practice Address - Fax:205-631-1611
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL49701223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51531288OtherBCBS OF ALABAMA PROVIDER#
AL1356891OtherUCCI PROVIDER #