Provider Demographics
NPI:1144756461
Name:DIAMOND SMILES HOMEWOOD
Entity Type:Organization
Organization Name:DIAMOND SMILES HOMEWOOD
Other - Org Name:DIAMOND SMILES DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDGAR
Authorized Official - Middle Name:
Authorized Official - Last Name:LUNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-847-1415
Mailing Address - Street 1:112 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:AL
Mailing Address - Zip Code:35209-5312
Mailing Address - Country:US
Mailing Address - Phone:205-847-1415
Mailing Address - Fax:205-795-3499
Practice Address - Street 1:112 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:AL
Practice Address - Zip Code:35209-5312
Practice Address - Country:US
Practice Address - Phone:205-847-1415
Practice Address - Fax:205-795-3499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-05
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty