Provider Demographics
NPI:1285710889
Name:DENTAL CARE OF ALABAMA LLC
Entity type:Organization
Organization Name:DENTAL CARE OF ALABAMA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAWFORD
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:BADHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-595-2273
Mailing Address - Street 1:4500 MONTEVALLO RD
Mailing Address - Street 2:SUITE B 105
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35210-3129
Mailing Address - Country:US
Mailing Address - Phone:205-595-2273
Mailing Address - Fax:205-595-2235
Practice Address - Street 1:4500 MONTEVALLO RD
Practice Address - Street 2:SUITE B 105
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35210-3129
Practice Address - Country:US
Practice Address - Phone:205-595-2273
Practice Address - Fax:205-595-2235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3077261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental