Provider Demographics
NPI:1609022722
Name:DR KENNETH FRANK TICHANSKY D.M.D.
Entity Type:Organization
Organization Name:DR KENNETH FRANK TICHANSKY D.M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:TICHANSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-326-6613
Mailing Address - Street 1:2011 9TH AVE SO.
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205
Mailing Address - Country:US
Mailing Address - Phone:205-326-6613
Mailing Address - Fax:205-326-6614
Practice Address - Street 1:2011 9TH AVE SO.
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205
Practice Address - Country:US
Practice Address - Phone:205-326-6613
Practice Address - Fax:205-326-6614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-08
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL31321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty