Healthcare Provider Details

I. General information

NPI: 1295965721
Provider Name (Legal Business Name): SMILE DESIGN CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2009
Last Update Date: 07/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 SOUTH GILMER AVE.
LANETT AL
36863-0549
US

IV. Provider business mailing address

PO BOX 549 1601 SOUTH GILMER AVE.
LANETT AL
36863-0549
US

V. Phone/Fax

Practice location:
  • Phone: 334-644-2422
  • Fax: 334-644-4575
Mailing address:
  • Phone: 334-644-2422
  • Fax: 334-644-4575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES GRADY HAWKINS
Title or Position: PRESIDENT/OWNER
Credential: D.M.D.
Phone: 334-644-2422