Provider Demographics
NPI:1013435346
Name:SMART DENTAL HOLDINGS, LLC
Entity Type:Organization
Organization Name:SMART DENTAL HOLDINGS, LLC
Other - Org Name:SOUTHLAKE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REVENUE CYCLE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-477-4242
Mailing Address - Street 1:5751 POCAHONTAS RD STE A
Mailing Address - Street 2:
Mailing Address - City:BESSEMER
Mailing Address - State:AL
Mailing Address - Zip Code:35022-5478
Mailing Address - Country:US
Mailing Address - Phone:205-477-4242
Mailing Address - Fax:205-477-4243
Practice Address - Street 1:4501 SOUTHLAKE PKWY
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-3644
Practice Address - Country:US
Practice Address - Phone:205-955-5656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MCCALLA FAMILY DENTISTRY, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-09-07
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental