Provider Demographics
NPI:1659432532
Name:SMARTSMILES ORTHODONTICS, PC
Entity Type:Organization
Organization Name:SMARTSMILES ORTHODONTICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FOCH
Authorized Official - Middle Name:M
Authorized Official - Last Name:SMART
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:334-271-2345
Mailing Address - Street 1:315 RAY THORINGTON ROAD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117
Mailing Address - Country:US
Mailing Address - Phone:334-271-2345
Mailing Address - Fax:
Practice Address - Street 1:315 RAY THORINGTON ROAD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117
Practice Address - Country:US
Practice Address - Phone:334-271-2345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL47391223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty