Provider Demographics
NPI:1053019117
Name:BIRMINGHAM DENTAL, PLLC
Entity type:Organization
Organization Name:BIRMINGHAM DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:SHELDEN
Authorized Official - Last Name:CRAMER
Authorized Official - Suffix:III
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-837-5602
Mailing Address - Street 1:543 FOUNDERS PARK CIR
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35226-4148
Mailing Address - Country:US
Mailing Address - Phone:205-837-5602
Mailing Address - Fax:
Practice Address - Street 1:1021 19TH ST S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-4803
Practice Address - Country:US
Practice Address - Phone:205-837-5602
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty