Provider Demographics
NPI:1366620155
Name:BIRMINGHAM PEDIATRIC DENTAL CARE ASSOCIATES
Entity type:Organization
Organization Name:BIRMINGHAM PEDIATRIC DENTAL CARE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:B
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-933-1363
Mailing Address - Street 1:1613 11TH AVE S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-4703
Mailing Address - Country:US
Mailing Address - Phone:205-933-1363
Mailing Address - Fax:205-933-1365
Practice Address - Street 1:1613 11TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-4703
Practice Address - Country:US
Practice Address - Phone:205-933-1363
Practice Address - Fax:205-933-1365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL26931223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty