Provider Demographics
NPI:1235227828
Name:CAROL ANN D. NICROSI DMD, MS, PC
Entity Type:Organization
Organization Name:CAROL ANN D. NICROSI DMD, MS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:NICROSI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-631-4572
Mailing Address - Street 1:1324 MAIN ST.
Mailing Address - Street 2:P.O. BOX 908
Mailing Address - City:GARDENDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35071
Mailing Address - Country:US
Mailing Address - Phone:205-631-4572
Mailing Address - Fax:205-631-4979
Practice Address - Street 1:1324 MAIN ST
Practice Address - Street 2:
Practice Address - City:GARDENDALE
Practice Address - State:AL
Practice Address - Zip Code:35071
Practice Address - Country:US
Practice Address - Phone:205-631-4572
Practice Address - Fax:205-631-4979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL47251223P0221X
AL37251223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-06005OtherBCBS PROVIDER #
AL51505999OtherBCBS PROVDIER #