Provider Demographics
NPI:1396327177
Name:MX6, LLC
Entity type:Organization
Organization Name:MX6, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:MCCRACKEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-633-1900
Mailing Address - Street 1:621 HELEN KELLER BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35404-2962
Mailing Address - Country:US
Mailing Address - Phone:205-633-1900
Mailing Address - Fax:205-633-1154
Practice Address - Street 1:621 HELEN KELLER BLVD STE 100
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404-2962
Practice Address - Country:US
Practice Address - Phone:205-633-1900
Practice Address - Fax:205-633-1154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL5196OtherDENTAL LICENSE
AL5230OtherDENTAL LICENSE