Provider Demographics
NPI:1205319605
Name:PAD ORTHO LLC
Entity type:Organization
Organization Name:PAD ORTHO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-982-0112
Mailing Address - Street 1:1015 BROCKS GAP PKWY
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-4032
Mailing Address - Country:US
Mailing Address - Phone:205-982-0112
Mailing Address - Fax:205-982-0737
Practice Address - Street 1:1015 BROCKS GAP PKWY
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-4032
Practice Address - Country:US
Practice Address - Phone:205-982-0112
Practice Address - Fax:205-982-0737
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEDIATRIC AND ADOLESCENT DENTISTRY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-09-11
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty