Provider Demographics
NPI:1487914198
Name:SIDES, ELAINE FRANCES (DMD)
Entity type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:FRANCES
Last Name:SIDES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2554 ROCKY RIDGE ROAD
Mailing Address - Street 2:BIRMINGHAM
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35243
Mailing Address - Country:US
Mailing Address - Phone:205-222-0969
Mailing Address - Fax:205-822-1500
Practice Address - Street 1:5720 FIRST AVENUE SOUTH
Practice Address - Street 2:BIRMINGHAM
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35212
Practice Address - Country:US
Practice Address - Phone:205-380-9455
Practice Address - Fax:205-380-9459
Is Sole Proprietor?:No
Enumeration Date:2012-05-29
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5843122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist