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Individual
DINO C JACOVIDES
Active
Individual
DINO C JACOVIDES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
4166
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1303418
UNITED CONCORDIA
AL
01
—
40992
BC BS OF AL
AL
Enumeration date
09/06/2007
Last updated
09/06/2007
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