Healthcare Provider Details

I. General information

NPI: 1457346298
Provider Name (Legal Business Name): JOHN STEFAN POCZATEK DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 12/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5751 POCAHONTAS RD SUITE A
BESSEMER AL
35022-5476
US

IV. Provider business mailing address

5751 POCAHONTAS RD SUITE A
BESSEMER AL
35022-5476
US

V. Phone/Fax

Practice location:
  • Phone: 205-477-4242
  • Fax:
Mailing address:
  • Phone: 205-427-5582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5345
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: