Provider Demographics
NPI:1881861631
Name:SMILES FROM US, PLLC
Entity Type:Organization
Organization Name:SMILES FROM US, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:STANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:334-358-6411
Mailing Address - Street 1:2600 BELL RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-4375
Mailing Address - Country:US
Mailing Address - Phone:334-358-6411
Mailing Address - Fax:334-351-0033
Practice Address - Street 1:2600 BELL RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-4375
Practice Address - Country:US
Practice Address - Phone:334-358-6411
Practice Address - Fax:334-351-0033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-12
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL28651223P0221X
AL48691223P0221X
AL50531223P0221X
AL52211223P0221X
AL51991223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-23254OtherBLUE CROSS BLUE SHIELD OF ALABAMA
AL515-25517OtherBLUE CROSS BLUE SHIELD OF ALABAMA
AL515-28153OtherBLUE CROSS BLUE SHIELD OF ALABAMA
AL009965115Medicaid
AL515-19534OtherBLUE CROSS BLUE SHIELD OF ALABAMA
AL510-60720OtherBLUE CROSS BLUE SHIELD OF ALABAMA
AL770948OtherUNITED CONCORDIA
AL515-23250OtherBLUE CROSS BLUE SHIELD OF ALABAMA
AL515-25362OtherBLUE CROSS BLUE SHIELD OF ALABAMA
AL515-23249OtherBLUE CROSS BLUE SHIELD OF ALABAMA
AL515-28152OtherBLUE CROSS BLUE SHIELD OF ALABAMA