Healthcare Provider Details

I. General information

NPI: 1679662126
Provider Name (Legal Business Name): JAMES A. SMITH JR. D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 20TH ST S
BIRMINGHAM AL
35205-4916
US

IV. Provider business mailing address

1500 20TH ST S
BIRMINGHAM AL
35205-4916
US

V. Phone/Fax

Practice location:
  • Phone: 205-933-8544
  • Fax: 205-933-8412
Mailing address:
  • Phone: 205-933-8544
  • Fax: 205-933-8412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number3636
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: