Provider Demographics
NPI:1336518331
Name:SEA SMILES, LLC
Entity Type:Organization
Organization Name:SEA SMILES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:O'NEILL
Authorized Official - Last Name:MEADOR
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:850-712-5024
Mailing Address - Street 1:825 N ALSTON ST
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535-3509
Mailing Address - Country:US
Mailing Address - Phone:251-943-7575
Mailing Address - Fax:
Practice Address - Street 1:825 N ALSTON ST
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-3509
Practice Address - Country:US
Practice Address - Phone:251-943-7575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-20
Last Update Date:2015-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL57891223P0221X
AL58111223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty