1861400947 NPI number — DR. GEORGE EARL HYDRICK D.D.S.;P.A.

Table of content: DR. GEORGE EARL HYDRICK D.D.S.;P.A. (NPI 1861400947)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861400947 NPI number — DR. GEORGE EARL HYDRICK D.D.S.;P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HYDRICK
Provider First Name:
GEORGE
Provider Middle Name:
EARL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.;P.A.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861400947
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2902 HAWTHORNE CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUSCALOOSA
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35406-1690
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-750-8008
Provider Business Mailing Address Fax Number:
205-750-8152

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 UNIVERSITY BLVD E
Provider Second Line Business Practice Location Address:
SUITE B-3
Provider Business Practice Location Address City Name:
TUSCALOOSA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35401-2067
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-750-8008
Provider Business Practice Location Address Fax Number:
205-750-8152
Provider Enumeration Date:
08/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  3428 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 510-93555 . This is a "BCBS OF AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 604459 . This is a "UCCI" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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