Organization
BIRMINGHAM ENDODONTICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KRISSIE BAKER AYCOCK (BUSINESS MANAGER)
(205) 981-3301
Entity
Organization
Contact information
Practice address
202 INVERNESS CENTER DR, SUITE 202, BIRMINGHAM, AL 35242-7635
(205) 981-3301
(205) 981-3307
Mailing address
202 INVERNESS CENTER DRIVE, SUITE 202, BIRMINGHAM, AL 35242-7635
(205) 981-3301
(205) 981-3307
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
272124
UCCI PROVIDER
AL
01
—
4289
CISSELL STATE LICENSE
AL
01
—
5041
CAPRARA STATE LICENSE
AL
01
—
51035548
BCBS AL PROVIDER
AL
01
—
51509043
BCBS AL PROVIDER
AL
Enumeration date
09/20/2006
Last updated
08/22/2020
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