Provider Demographics
NPI:1760558167
Name:CAPSTONE DENTAL CARE
Entity Type:Organization
Organization Name:CAPSTONE DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:T
Authorized Official - Last Name:DICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-248-9077
Mailing Address - Street 1:100 RICE MINE RD N
Mailing Address - Street 2:SUITE D
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-2300
Mailing Address - Country:US
Mailing Address - Phone:205-248-9077
Mailing Address - Fax:205-248-9076
Practice Address - Street 1:100 RICE MINE RD N
Practice Address - Street 2:SUITE D
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-2300
Practice Address - Country:US
Practice Address - Phone:205-248-9077
Practice Address - Fax:205-248-9076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL49901223G0001X
AL49991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty