Provider Demographics
NPI:1083446025
Name:BIRMINGHAM EMERGENCY DENTAL
Entity type:Organization
Organization Name:BIRMINGHAM EMERGENCY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRENNAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:307-315-7301
Mailing Address - Street 1:4616 MONTEVALLO RD STE 200
Mailing Address - Street 2:
Mailing Address - City:IRONDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35210-3104
Mailing Address - Country:US
Mailing Address - Phone:307-315-7301
Mailing Address - Fax:
Practice Address - Street 1:4616 MONTEVALLO RD STE 200
Practice Address - Street 2:
Practice Address - City:IRONDALE
Practice Address - State:AL
Practice Address - Zip Code:35210-3104
Practice Address - Country:US
Practice Address - Phone:307-315-7301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental