Provider Demographics
NPI:1861400947
Name:HYDRICK, GEORGE EARL (DDS;PA)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:EARL
Last Name:HYDRICK
Suffix:
Gender:M
Credentials:DDS;PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2902 HAWTHORNE CIR
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-1690
Mailing Address - Country:US
Mailing Address - Phone:205-750-8008
Mailing Address - Fax:205-750-8152
Practice Address - Street 1:600 UNIVERSITY BLVD E
Practice Address - Street 2:SUITE B-3
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-2067
Practice Address - Country:US
Practice Address - Phone:205-750-8008
Practice Address - Fax:205-750-8152
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3428122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-93555OtherBCBS OF AL
AL604459OtherUCCI