Provider Demographics
NPI:1477840056
Name:BIVONA, MICHAEL JACOB (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JACOB
Last Name:BIVONA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5305 10TH CT S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35222-4013
Mailing Address - Country:US
Mailing Address - Phone:205-601-3052
Mailing Address - Fax:
Practice Address - Street 1:1430 3RD AVE N
Practice Address - Street 2:
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35020-5609
Practice Address - Country:US
Practice Address - Phone:205-428-2086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-05
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL58481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice