Healthcare Provider Details

I. General information

NPI: 1235227828
Provider Name (Legal Business Name): CAROL ANN D. NICROSI DMD, MS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1324 MAIN ST
GARDENDALE AL
35071
US

IV. Provider business mailing address

1324 MAIN ST. P.O. BOX 908
GARDENDALE AL
35071
US

V. Phone/Fax

Practice location:
  • Phone: 205-631-4572
  • Fax: 205-631-4979
Mailing address:
  • Phone: 205-631-4572
  • Fax: 205-631-4979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number3725
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number4725
License Number StateAL

VIII. Authorized Official

Name: DR. CAROL ANN NICROSI
Title or Position: DENTIST
Credential: DMD
Phone: 205-631-4572