# BIVENS DENTAL GROUP PC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** BIVENS DENTAL GROUP PC
- **Other names:** Hickman Dental Center
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1871747832
- **Legal business name:** BIVENS DENTAL GROUP PC
- **Authorized official:** DARRYL A BIVENS DDS (DENTIST)
- **Authorized official phone:** (931) 670-5961

## Contact information

- **Practice address:** 5103 HIGHWAY 100, LYLES, TN 37098-1879
- **Practice address phone:** (931) 670-5961
- **Mailing address:** 5103 HIGHWAY 100, LYLES, TN 37098-1879
- **Mailing address phone:** (931) 670-5961

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | 6858 | TN | Yes |

## Other

- **Enumeration date:** 11/04/2008
- **Last updated:** 11/05/2008