Provider Demographics
NPI:1952099111
Name:SMILECREATOR OF ALABAMA LLC
Entity Type:Organization
Organization Name:SMILECREATOR OF ALABAMA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:NILO
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:256-373-8333
Mailing Address - Street 1:191 HERREN CAMP RD
Mailing Address - Street 2:
Mailing Address - City:DADEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36853-6719
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:191 HERREN CAMP RD
Practice Address - Street 2:
Practice Address - City:DADEVILLE
Practice Address - State:AL
Practice Address - Zip Code:36853-6719
Practice Address - Country:US
Practice Address - Phone:256-373-8333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Multi-Specialty