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General NPI Number Information
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NPI Number | 1285988758
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Entity Type | Organization
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Legal Business Name | BIVONA FAMILY DENTAL
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Dates
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Enumeration Date | 11/05/2012
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Last Update Date | 11/05/2012
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Provider Practice Location Address
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Address Line | 1206 HIGHWAY 78 E
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City | JASPER
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State | AL
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Zip | 35501-3939
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Country | US
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Telephone | 205-387-8888
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Fax | 205-387-8118
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Provider Business Mailing Address
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Address Line | 1206 HIGHWAY 78 E
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City | JASPER
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State | AL
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Zip | 35501-3939
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Country | US
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Telephone | 205-387-8888
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Fax | 205-387-8118
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Authorized Official
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Title or Position | DENTIST
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Name | DR. MICHAEL JACOB BIVONA
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Credential | DMD
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Telephone | 205-387-8888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 5848
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License Number State | AL
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