Healthcare Provider Details

I. General information

NPI: 1780019695
Provider Name (Legal Business Name): STONECREEK ACQUISITIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2013
Last Update Date: 08/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1633 MONTGOMERY HWY STE 5
HOOVER AL
35216-4908
US

IV. Provider business mailing address

1633 MONTGOMERY HWY STE 5
HOOVER AL
35216-4908
US

V. Phone/Fax

Practice location:
  • Phone: 205-979-6005
  • Fax: 205-979-6073
Mailing address:
  • Phone: 205-979-6005
  • Fax: 205-979-6073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number3968
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. RON BEASLEY
Title or Position: OWNER
Credential: DMD
Phone: 205-979-6005