Provider Demographics
NPI:1790258671
Name:STONECREEK ACQUISITIONS, L.L.C.
Entity Type:Organization
Organization Name:STONECREEK ACQUISITIONS, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANETTE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:CIPCIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-655-5144
Mailing Address - Street 1:5750 BENTLEY WAY
Mailing Address - Street 2:
Mailing Address - City:TRUSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35173-6700
Mailing Address - Country:US
Mailing Address - Phone:205-655-5144
Mailing Address - Fax:
Practice Address - Street 1:5750 BENTLEY WAY
Practice Address - Street 2:
Practice Address - City:TRUSSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35173-6700
Practice Address - Country:US
Practice Address - Phone:205-655-5144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STONECREEK ACQUISITIONS, L.L.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty