Shoal Creek Dental | |
1303 Highway 72 Killen AL 35645-9136 | |
(256) 757-5314 | |
Not Available |
Full Name | Shoal Creek Dental |
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Speciality | Clinic/center - Dental |
Location | 1303 Highway 72, Killen, Alabama |
Authorized Official Name and Position | Bruce Evans (OWNER) |
Authorized Official Contact | 2567668800 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Shoal Creek Dental 1303 Highway 72 Killen AL 35645-9136 Ph: (256) 757-5314 | Shoal Creek Dental 1303 Highway 72 Killen AL 35645-9136 Ph: (256) 757-5314 |
NPI Number | 1194216861 |
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Provider Enumeration Date | 05/29/2018 |
Last Update Date | 05/29/2018 |
Identifier | Type | State | Issuer |
---|---|---|---|
1194216861 | NPI | - | NPPES |
164755 | Medicaid | AL |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QD0000X | Clinic/center - Dental | 3415 (Alabama) | Primary |
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