Healthcare Provider Details

I. General information

NPI: 1477244481
Provider Name (Legal Business Name): NICOL GHOBAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2023
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 7TH AVE S
BIRMINGHAM AL
35233-2005
US

IV. Provider business mailing address

7121 WYNNFIELD DR S
MOBILE AL
36695-2573
US

V. Phone/Fax

Practice location:
  • Phone: 205-934-3387
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD.007690-C1
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: