Provider Demographics
NPI:1831377993
Name:MCCALLA ORTHODONTICS AND PEDIATRIC DENTISTRY, P.C.
Entity type:Organization
Organization Name:MCCALLA ORTHODONTICS AND PEDIATRIC DENTISTRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SANCHEZ-HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS, MS
Authorized Official - Phone:205-477-8004
Mailing Address - Street 1:4764 EASTERN VALLEY RD STE 104-106
Mailing Address - Street 2:
Mailing Address - City:MC CALLA
Mailing Address - State:AL
Mailing Address - Zip Code:35111-3469
Mailing Address - Country:US
Mailing Address - Phone:205-477-8004
Mailing Address - Fax:
Practice Address - Street 1:4764 EASTERN VALLEY RD
Practice Address - Street 2:SUITE 104-106
Practice Address - City:MC CALLA
Practice Address - State:AL
Practice Address - Zip Code:35111-3469
Practice Address - Country:US
Practice Address - Phone:205-477-8004
Practice Address - Fax:205-477-8214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL49561223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1364757OtherUNITED CONCORDIA
AL51523968OtherBCBS