Provider Demographics
NPI:1346596715
Name:ACIPCO DENTAL GROUP, INC
Entity Type:Organization
Organization Name:ACIPCO DENTAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:REDMOND
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-325-7004
Mailing Address - Street 1:P.O. BOX 12725
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35202-2725
Mailing Address - Country:US
Mailing Address - Phone:205-325-7004
Mailing Address - Fax:205-325-1976
Practice Address - Street 1:3200 16TH ST N
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35207-4202
Practice Address - Country:US
Practice Address - Phone:205-325-7004
Practice Address - Fax:205-325-1976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-03
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL52131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty