Provider Demographics
NPI:1659057206
Name:STONECREEK DENTAL OF ALABAMA
Entity Type:Organization
Organization Name:STONECREEK DENTAL OF ALABAMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RCM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-919-1750
Mailing Address - Street 1:511 BROOKWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-6801
Mailing Address - Country:US
Mailing Address - Phone:205-879-6880
Mailing Address - Fax:
Practice Address - Street 1:511 BROOKWOOD BLVD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-6801
Practice Address - Country:US
Practice Address - Phone:205-879-6880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STONECREEK DENTAL OF ALABAMA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental