Provider Demographics
NPI:1700178654
Name:VITAL SMILES ALABAMA, P. C.
Entity Type:Organization
Organization Name:VITAL SMILES ALABAMA, P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:D D S
Authorized Official - Phone:205-271-6851
Mailing Address - Street 1:2525 CENTER POINT PKWY
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35215-2548
Mailing Address - Country:US
Mailing Address - Phone:205-854-8093
Mailing Address - Fax:205-854-8095
Practice Address - Street 1:2525 CENTER POINT PKWY
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35215-2548
Practice Address - Country:US
Practice Address - Phone:205-271-6851
Practice Address - Fax:205-271-6836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-11
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL30611223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty