Healthcare Provider Details

I. General information

NPI: 1003410879
Provider Name (Legal Business Name): BRITTNEY T DEBRUCE RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2020
Last Update Date: 11/23/2020
Certification Date: 11/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5720 1ST AVE S
BIRMINGHAM AL
35212-2522
US

IV. Provider business mailing address

5720 1ST AVE S
BIRMINGHAM AL
35212-2522
US

V. Phone/Fax

Practice location:
  • Phone: 205-380-9446
  • Fax: 205-380-9446
Mailing address:
  • Phone: 205-380-9446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number8034
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: