Provider Demographics
NPI:1417196551
Name:SOUTHERN DENTAL BIRMINGHAM, LLC
Entity Type:Organization
Organization Name:SOUTHERN DENTAL BIRMINGHAM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:DRAYTON
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:III
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-991-2433
Mailing Address - Street 1:4960 VALLEYDALE RD
Mailing Address - Street 2:STE 100
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-4613
Mailing Address - Country:US
Mailing Address - Phone:205-991-2433
Mailing Address - Fax:205-380-0623
Practice Address - Street 1:4960 VALLEYDALE RD
Practice Address - Street 2:STE 100
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-4613
Practice Address - Country:US
Practice Address - Phone:205-991-2433
Practice Address - Fax:205-380-0623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-12
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL50241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty