Individual
BRUCE D EVANS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD,PC
Contact information
Practice address
1947 FLORENCE BLVD, FLORENCE, AL 35630-2729
(256) 766-8800
Mailing address
1947 FLORENCE BLVD, FLORENCE, AL 35630-2729
(256) 766-8800
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
AL3415
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009947460
—
AL
01
—
650503830
T.I.N
AL
01
—
79378
STATE ID.#
AL
01
—
843054
UNITED CONCORD
AL
01
—
92029
BLUE CROSS BLUE SHIELD
AL
Enumeration date
01/19/2007
Last updated
07/09/2007
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