Organization
HICKORY HILLS DENTAL CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IAN KYLE FAWCETT DMD (OWNER)
(256) 766-8800
Entity
Organization
Contact information
Practice address
1947 FLORENCE BLVD, FLORENCE, AL 35630-2729
(256) 766-8800
(256) 766-8936
Mailing address
1947 FLORENCE BLVD, FLORENCE, AL 35630-2729
(256) 766-8800
(256) 766-8936
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
207491
—
AL
Enumeration date
10/10/2018
Last updated
10/10/2018
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