Provider Demographics
NPI:1164571410
Name:SMITH, EDWIN L (DMD)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:L
Last Name:SMITH
Suffix:
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 1:1932 LAUREL RD
Mailing Address - Street 2:SUITE 2D
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35216
Mailing Address - Country:US
Mailing Address - Phone:205-823-4801
Mailing Address - Fax:205-823-4803
Practice Address - Street 1:1932 LAUREL RD
Practice Address - Street 2:SUITE 2D
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35216
Practice Address - Country:US
Practice Address - Phone:205-823-4801
Practice Address - Fax:205-823-4803
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL25381223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics