Organization
BRUCE D. EVANS
Active
Other names
Hickory Hills Dental Care
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. STACEY L EVANS (OFFICE CORDINATOR)
(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
1223G0001X
General Practice Dentistry
Primary
3415
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009947460
—
AL
01
—
0843054
UNITED CONCORDIA
—
01
—
515-38965
BLUE CROSS BLUE SHIELD
AL
Enumeration date
04/24/2012
Last updated
04/24/2012
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