Provider Demographics
NPI:1679969588
Name:BIRMINGHAM ORTHODONTICS
Entity type:Organization
Organization Name:BIRMINGHAM ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-733-2022
Mailing Address - Street 1:3825 LORNA RD
Mailing Address - Street 2:SUITE 248
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-3005
Mailing Address - Country:US
Mailing Address - Phone:205-733-2022
Mailing Address - Fax:205-733-9671
Practice Address - Street 1:3825 LORNA RD
Practice Address - Street 2:SUITE 248
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-3005
Practice Address - Country:US
Practice Address - Phone:205-733-2022
Practice Address - Fax:205-733-9671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-08
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL38711223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty