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General NPI Number Information
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NPI Number | 1760558167
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Entity Type | Organization
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Legal Business Name | CAPSTONE DENTAL CARE
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 100 RICE MINE RD N SUITE D
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City | TUSCALOOSA
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State | AL
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Zip | 35406-2300
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Country | US
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Telephone | 205-248-9077
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Fax | 205-248-9076
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Provider Business Mailing Address
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Address Line | 100 RICE MINE RD N SUITE D
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City | TUSCALOOSA
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State | AL
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Zip | 35406-2300
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Country | US
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Telephone | 205-248-9077
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Fax | 205-248-9076
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Authorized Official
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Title or Position | DENTIST
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Name | DR. JENNIFER T DICKSON
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Credential | DMD
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Telephone | 205-248-9077
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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 | 4999
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 4990
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License Number State | AL
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