Provider Demographics
NPI:1013407923
Name:PROFESSIONAL SMILES, LLC
Entity Type:Organization
Organization Name:PROFESSIONAL SMILES, LLC
Other - Org Name:INVERNESS SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUNNY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-201-1002
Mailing Address - Street 1:3549 BERMUDA DR
Mailing Address - Street 2:
Mailing Address - City:IRONDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35210-3028
Mailing Address - Country:US
Mailing Address - Phone:706-201-1002
Mailing Address - Fax:205-995-3990
Practice Address - Street 1:5291 VALLEYDALE RD STE 129
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-7707
Practice Address - Country:US
Practice Address - Phone:205-995-3989
Practice Address - Fax:205-995-3990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL61211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty