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General NPI Number Information
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NPI Number | 1942394820
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Entity Type | Organization
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Legal Business Name | DENTAL ASSOCIATES OF TUSCALOOSA LLC
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 217 MCFARLAND CIRCLE NORTH
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City | TUSCALOOSA
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State | AL
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Zip | 34506
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Country | US
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Telephone | 205-345-7755
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Fax | 205-343-9075
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Provider Business Mailing Address
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Address Line | 217 MCFARLAND CIRCLE NORTH
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City | TUSCALOOSA
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State | AL
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Zip | 34506
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Country | US
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Telephone | 205-345-7755
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Fax | 205-343-9075
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | JERRY ANDREW FIKES
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Credential | DMD MAGD
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Telephone | 205-345-7755
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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 | 3162
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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 |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 5177
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License Number State | AL
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