Provider Demographics
NPI:1497940167
Name:JACOVIDES, DINO C (DMD)
Entity Type:Individual
Prefix:
First Name:DINO
Middle Name:C
Last Name:JACOVIDES
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 1:3142 CUHABA HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35243
Mailing Address - Country:US
Mailing Address - Phone:205-970-1866
Mailing Address - Fax:205-970-1896
Practice Address - Street 1:3142 CUHABA HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35243
Practice Address - Country:US
Practice Address - Phone:205-970-1866
Practice Address - Fax:205-970-1896
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4166122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1303418OtherUNITED CONCORDIA
AL40992OtherBC BS OF AL