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General NPI Number Information
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NPI Number | 1639738453
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Entity Type | Individual
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Provider Name | JESSIE GAIL STILL DMD
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Gender | Female
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Dates
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Enumeration Date | 06/06/2019
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Last Update Date | 06/06/2019
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Provider Practice Location Address
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Address Line | 205 CALDWELL DR
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City | WARRIOR
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State | AL
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Zip | 35180-1407
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Country | US
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Telephone | 334-672-2879
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Fax |
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Provider Business Mailing Address
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Address Line | 300 BEECH CIR APT 7102
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City | BIRMINGHAM
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State | AL
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Zip | 35213-2055
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Country | US
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Telephone | 334-672-2879
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0006633-C1
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License Number State | AL
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