Provider Demographics
NPI:1659574499
Name:JAMES WESTCOTT SAMFORD, DMD, LLC
Entity Type:Organization
Organization Name:JAMES WESTCOTT SAMFORD, DMD, LLC
Other - Org Name:DOUBLE OAK MOUNTAIN FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:SAMFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-991-8850
Mailing Address - Street 1:254 INVERNESS CENTER DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242
Mailing Address - Country:US
Mailing Address - Phone:205-991-8850
Mailing Address - Fax:205-991-3899
Practice Address - Street 1:254 INVERNESS CENTER DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242
Practice Address - Country:US
Practice Address - Phone:205-991-8850
Practice Address - Fax:205-991-3899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL53471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty