Provider Demographics
NPI:1497244438
Name:SMILE DOCTORS OF ALABAMA, PC
Entity Type:Organization
Organization Name:SMILE DOCTORS OF ALABAMA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:V
Authorized Official - Last Name:LAW
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:912-384-1560
Mailing Address - Street 1:1214 PETERSON AVE N STE G
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31533-2836
Mailing Address - Country:US
Mailing Address - Phone:912-384-1560
Mailing Address - Fax:
Practice Address - Street 1:535 JACK WARNER PKWY NE STE D
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404-5715
Practice Address - Country:US
Practice Address - Phone:205-556-2600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-04
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALD6253C1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty