Provider Demographics
NPI:1316833353
Name:FCDALT, LLC
Entity type:Organization
Organization Name:FCDALT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAHEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:UPTON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-821-1976
Mailing Address - Street 1:2757 GREEN SPRINGS HWY
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-4903
Mailing Address - Country:US
Mailing Address - Phone:205-874-9605
Mailing Address - Fax:
Practice Address - Street 1:1110 N CHALKVILLE RD STE 164
Practice Address - Street 2:
Practice Address - City:TRUSSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35173-1063
Practice Address - Country:US
Practice Address - Phone:205-235-1210
Practice Address - Fax:205-336-1151
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SRUPTON, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty