Healthcare Provider Details

I. General information

NPI: 1205596509
Provider Name (Legal Business Name): STONECREEK DENTAL OF ALABAMA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2021
Last Update Date: 12/28/2021
Certification Date: 12/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8301 HIGHWAY 31 N STE 109
MORRIS AL
35116-1301
US

IV. Provider business mailing address

8301 HIGHWAY 31 N STE 109
MORRIS AL
35116-1301
US

V. Phone/Fax

Practice location:
  • Phone: 205-647-2050
  • Fax:
Mailing address:
  • Phone: 205-647-2050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VERONICA JACKSON
Title or Position: REVENUE CYCLE MANAGER
Credential:
Phone: 205-538-5464