Organization
BIG WAVE DENTISTRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRADLEY JOSHUA HILLMAN DDS (DENTIST/OWNER)
(501) 231-7666
Entity
Organization
Contact information
Practice address
110 S ALSTON ST, FOLEY, AL 36535-1912
(251) 213-9820
Mailing address
635 GLEN EAGLES AVE, GULF SHORES, AL 36542-9036
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1447789045
FFS
AL
Enumeration date
03/27/2020
Last updated
03/27/2020
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