Provider Demographics
NPI:1508203605
Name:SOUTHERN SMILES, PC
Entity Type:Organization
Organization Name:SOUTHERN SMILES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:KREMPA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:251-344-0230
Mailing Address - Street 1:6350 AIRPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-3163
Mailing Address - Country:US
Mailing Address - Phone:251-344-0230
Mailing Address - Fax:
Practice Address - Street 1:6350 AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-3163
Practice Address - Country:US
Practice Address - Phone:251-344-0230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-29
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5994261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental