Provider Demographics
NPI:1063592525
Name:FIKES, JERRY ANDREW (DMD MAGD)
Entity type:Individual
Prefix:
First Name:JERRY
Middle Name:ANDREW
Last Name:FIKES
Suffix:
Gender:M
Credentials:DMD MAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 MCFARLAND CIRCLE NORTH
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406
Mailing Address - Country:US
Mailing Address - Phone:205-345-7755
Mailing Address - Fax:205-343-9075
Practice Address - Street 1:217 MCFARLAND CIRCLE NORTH
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406
Practice Address - Country:US
Practice Address - Phone:205-345-7755
Practice Address - Fax:205-343-9075
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3162122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51506076OtherBLUE CROSS BLUE SHIELD