Healthcare Provider Details

I. General information

NPI: 1578692372
Provider Name (Legal Business Name): DENTIST IN ACTION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 RED LANE RD STE F
BIRMINGHAM AL
35215-8246
US

IV. Provider business mailing address

524 RED LANE RD STE F
BIRMINGHAM AL
35215-8246
US

V. Phone/Fax

Practice location:
  • Phone: 205-836-4044
  • Fax: 205-836-4311
Mailing address:
  • Phone: 205-836-4044
  • Fax: 205-836-4311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number4492
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3138
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3679
License Number StateAL
# 4
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4065
License Number StateAL
# 5
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number4394
License Number StateAL
# 6
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5423
License Number StateAL

VIII. Authorized Official

Name: DR. ADOLPHUS MYRON JACKSON
Title or Position: DENTIST
Credential: DMD
Phone: 205-836-4044