Provider Demographics
NPI:1801548227
Name:STONECREEK DENTAL OF ALABAMA
Entity type:Organization
Organization Name:STONECREEK DENTAL OF ALABAMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE 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 1:202 INVERNESS CENTER DR STE 301
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-7636
Mailing Address - Country:US
Mailing Address - Phone:205-991-8939
Mailing Address - Fax:
Practice Address - Street 1:202 INVERNESS CENTER DR STE 301
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35242-7636
Practice Address - Country:US
Practice Address - Phone:205-991-8939
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000OtherNONE