Provider Demographics
NPI:1992584494
Name:STONECREEK DENTAL OF ALABAMA,LLC
Entity type:Organization
Organization Name:STONECREEK DENTAL OF ALABAMA,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-919-1750
Mailing Address - Street 1:6 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDER CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35010-1913
Mailing Address - Country:US
Mailing Address - Phone:256-234-6401
Mailing Address - Fax:
Practice Address - Street 1:6 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:ALEXANDER CITY
Practice Address - State:AL
Practice Address - Zip Code:35010-1913
Practice Address - Country:US
Practice Address - Phone:256-234-6401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STONECREEK DENTAL OF ALABAMA,LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental