Organization
REGIONAL DENTAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM BRUCE YOUNG D.O (OWNER)
(256) 435-4464
Entity
Organization
Contact information
Practice address
505 PELHAM RD S, JACKSONVILLE, AL 36265-2775
(256) 435-4464
(256) 435-2079
Mailing address
505 PELHAM RD S, JACKSONVILLE, AL 36265-2775
(256) 435-4464
(256) 435-2079
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3308
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000097747
—
AL
01
—
3308
DELTA
AL
01
—
51097747
BLUE CROSS BLUE SHEILD OF ALABAMA
AL
01
—
793127
UNITED CONCORDIA
AL
Enumeration date
03/26/2014
Last updated
04/04/2023
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