Provider Demographics
NPI:1053463919
Name:BROOKWOOD DENTISTRY PC
Entity Type:Organization
Organization Name:BROOKWOOD DENTISTRY PC
Other - Org Name:ANDREW J CRAFT DMD PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAFT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-871-3523
Mailing Address - Street 1:2045 BROOKWOOD MEDICAL CTR DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-6874
Mailing Address - Country:US
Mailing Address - Phone:205-871-3523
Mailing Address - Fax:
Practice Address - Street 1:2045 BROOKWOOD MEDICAL CTR DR
Practice Address - Street 2:SUITE 2
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-6874
Practice Address - Country:US
Practice Address - Phone:205-871-3523
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL50131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty