Provider Demographics
NPI:1518153816
Name:CIBULSKI, ANDREA (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:
Last Name:CIBULSKI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402A COGSWELL AVE
Mailing Address - Street 2:
Mailing Address - City:PELL CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35125-2446
Mailing Address - Country:US
Mailing Address - Phone:205-338-2970
Mailing Address - Fax:205-338-7175
Practice Address - Street 1:402A COGSWELL AVE
Practice Address - Street 2:
Practice Address - City:PELL CITY
Practice Address - State:AL
Practice Address - Zip Code:35125-2446
Practice Address - Country:US
Practice Address - Phone:205-338-2970
Practice Address - Fax:205-338-7175
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL54111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL04630OtherPROVIDER NUMBER
AL04630OtherBCBS PROVIDER NUMBER