Provider Demographics
NPI:1982079042
Name:ALABAMA MOBILE DENTAL CARE, P.C.
Entity Type:Organization
Organization Name:ALABAMA MOBILE DENTAL CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:256-777-9992
Mailing Address - Street 1:22041 US HIGHWAY 72
Mailing Address - Street 2:SUITE C
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35613-2614
Mailing Address - Country:US
Mailing Address - Phone:256-216-5610
Mailing Address - Fax:
Practice Address - Street 1:22041 US HIGHWAY 72
Practice Address - Street 2:SUITE C
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35613-2614
Practice Address - Country:US
Practice Address - Phone:256-216-5610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5676261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental