Provider Demographics
NPI:1053833392
Name:MCCOOL, SAMANTHA SIMMONS (DMD)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:SIMMONS
Last Name:MCCOOL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1771 INDEPENDENCE CT STE 1
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35216-1232
Mailing Address - Country:US
Mailing Address - Phone:205-870-9871
Mailing Address - Fax:
Practice Address - Street 1:1771 INDEPENDENCE CT STE 1
Practice Address - Street 2:
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35216-1232
Practice Address - Country:US
Practice Address - Phone:205-870-9871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6405122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist