Provider Demographics
NPI:1134705478
Name:JEBELES ENDODONTICS, PC
Entity type:Organization
Organization Name:JEBELES ENDODONTICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:R
Authorized Official - Last Name:COOKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-980-8777
Mailing Address - Street 1:4647 HIGHWAY 280 STE E
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5032
Mailing Address - Country:US
Mailing Address - Phone:120-598-0877
Mailing Address - Fax:
Practice Address - Street 1:4647 HIGHWAY 280 STE E
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-5032
Practice Address - Country:US
Practice Address - Phone:205-980-8777
Practice Address - Fax:205-408-2965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-18
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental