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General NPI Number Information
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NPI Number | 1154748218
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Entity Type | Organization
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Legal Business Name | REGIONAL DENTAL CENTER
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Dates
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Enumeration Date | 03/26/2014
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Last Update Date | 04/04/2023
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Provider Practice Location Address
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Address Line | 505 PELHAM RD S
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City | JACKSONVILLE
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State | AL
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Zip | 36265-2775
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Country | US
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Telephone | 256-435-4464
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Fax | 256-435-2079
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Provider Business Mailing Address
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Address Line | 505 PELHAM RD S
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City | JACKSONVILLE
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State | AL
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Zip | 36265-2775
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Country | US
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Telephone | 256-435-4464
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Fax | 256-435-2079
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Authorized Official
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Title or Position | OWNER
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Name | DR. WILLIAM BRUCE YOUNG
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Credential | D.O
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Telephone | 256-435-4464
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 3308
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License Number State | AL
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