Provider Demographics
NPI:1497835391
Name:DUCKETT, ANDREW ROLLAND (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:ROLLAND
Last Name:DUCKETT
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 1:1830 14TH AVE S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-4969
Mailing Address - Country:US
Mailing Address - Phone:205-933-5511
Mailing Address - Fax:205-939-0150
Practice Address - Street 1:1830 14TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-4969
Practice Address - Country:US
Practice Address - Phone:205-933-5511
Practice Address - Fax:205-939-0150
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL46291223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics