Organization
SHOAL CREEK DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRUCE EVANS D.M.D. (OWNER)
(256) 766-8800
Entity
Organization
Contact information
Practice address
1303 HIGHWAY 72, KILLEN, AL 35645-9136
(256) 757-5314
Mailing address
1303 HIGHWAY 72, KILLEN, AL 35645-9136
(256) 757-5314
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
3415
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
164755
—
AL
Enumeration date
05/29/2018
Last updated
05/29/2018
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