Provider Demographics
NPI:1144341256
Name:SMITH, THOMAS GLEN II (DMD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:GLEN
Last Name:SMITH
Suffix:II
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2349 DANVILLE RD SW
Mailing Address - Street 2:SUITE 130
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35603-4284
Mailing Address - Country:US
Mailing Address - Phone:256-355-2561
Mailing Address - Fax:
Practice Address - Street 1:2349 DANVILLE RD SW
Practice Address - Street 2:SUITE 130
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35603-4284
Practice Address - Country:US
Practice Address - Phone:256-355-2561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3974122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist