Provider Demographics
NPI:1437602281
Name:DENTAL WELLNESS CENTER OF BIRMINGHAM
Entity type:Organization
Organization Name:DENTAL WELLNESS CENTER OF BIRMINGHAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLESIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-323-0454
Mailing Address - Street 1:2001 PARK PL
Mailing Address - Street 2:SUITE 835
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35203-2735
Mailing Address - Country:US
Mailing Address - Phone:205-323-0454
Mailing Address - Fax:205-323-0458
Practice Address - Street 1:2001 PARK PL
Practice Address - Street 2:SUITE 835
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35203-2735
Practice Address - Country:US
Practice Address - Phone:205-323-0454
Practice Address - Fax:205-323-0458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-28
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6130302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization