Provider Demographics
NPI:1245637859
Name:VITAL SMILES ALABAMA
Entity type:Organization
Organization Name:VITAL SMILES ALABAMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILIPP
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:205-271-6831
Mailing Address - Street 1:1900 CRESTWOOD BLVD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:IRONDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35210-2034
Mailing Address - Country:US
Mailing Address - Phone:205-271-6841
Mailing Address - Fax:205-271-6836
Practice Address - Street 1:111 B Y WILLIAMS SR DR
Practice Address - Street 2:
Practice Address - City:MIDFIELD
Practice Address - State:AL
Practice Address - Zip Code:35228-2218
Practice Address - Country:US
Practice Address - Phone:205-923-3172
Practice Address - Fax:205-923-3926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-25
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL30611223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty