MEDICARE: HILLCREST DENTAL CARE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1588122600
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HILLCREST DENTAL CARE, LLC

Provider Business Mailing Address
First Line	:	1100 HILLCREST RD STE A
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36695-3919
Country	:	US
Telephone Number	:	251-776-6878
Fax Number	:	251-776-6863

Provider Business Practice Location Address
First Line	:	1100 HILLCREST RD STE A
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36695-3919
Country	:	US
Telephone Number	:	251-776-6878
Fax Number	:	251-776-6863

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MELANIE DOWNEY
Credential	:
Telephone Number	:	251-776-6878

Provider Enumeration Date	:	03/07/2019
Last Update Date	:	03/07/2019

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