| Shoal Creek Dental | |
|
1303 Highway 72 Killen AL 35645-9136 | |
| (256) 757-5314 | |
| Not Available |
| Full Name | Shoal Creek Dental |
|---|---|
| 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 |
|---|---|
| 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 |
|---|---|
| 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 |
James Todd Chastain, Dmd, Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 150 J C Mauldin Hwy, Killen, AL 35645 Phone: 256-757-4143 Fax: 256-757-4074 | |
Willow Dental Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1367 Highway 72, Killen, AL 35645 Phone: 256-757-5313 | |
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