Organization · NPI-2

1917 Dental Clinic

Dentist · Birmingham, AL

NPI number1093452633
StatusActive
Last updated in NPPESMay 17, 2022

Details

NPI
1093452633
Entity type
Organization (NPI-2)
Legal business name
1917 Dental Clinic
Organization subpart
Yes
Enumeration date
May 16, 2022
Certification date
May 17, 2022
Last updated
May 17, 2022

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
122300000X Dentist––Yes

Practice location

3220 5th Ave S # 2022
Birmingham, AL 35222-2309

Phone 205-975-9842

Mailing address

3220 5th Ave S # 2022
Birmingham, AL 35222-2309

Phone 205-975-9842

Authorized official

Jacquiselyn Story
Business Office Director
2059345088

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