Provider Demographics
NPI:1578692372
Name:DENTIST IN ACTION
Entity Type:Organization
Organization Name:DENTIST IN ACTION
Other - Org Name:BIRMINGHAM EASTERN FAMILY DENTAL CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ADOLPHUS
Authorized Official - Middle Name:MYRON
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-836-4044
Mailing Address - Street 1:524 RED LANE RD STE F
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35215-8246
Mailing Address - Country:US
Mailing Address - Phone:205-836-4044
Mailing Address - Fax:205-836-4311
Practice Address - Street 1:524 RED LANE RD STE F
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35215-8246
Practice Address - Country:US
Practice Address - Phone:205-836-4044
Practice Address - Fax:205-836-4311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL44921223E0200X
AL31381223G0001X
AL36791223G0001X
AL40651223G0001X
AL54231223G0001X
AL43941223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Not Answered1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty