Healthcare Provider Details

I. General information

NPI: 1598543027
Provider Name (Legal Business Name): MAKING SMILES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2023
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7771 HIGHWAY 72 W STE B
MADISON AL
35758-8814
US

IV. Provider business mailing address

245 KELSEY LYNN LN
HUNTSVILLE AL
35806-2293
US

V. Phone/Fax

Practice location:
  • Phone: 312-888-6208
  • Fax:
Mailing address:
  • Phone: 256-403-7404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. SYDNEY SIMPSON
Title or Position: OWNER
Credential: DMD
Phone: 256-403-7404