Healthcare Provider Details

I. General information

NPI: 1396063434
Provider Name (Legal Business Name): SMILE FACTORY WELLNESS DENTAL CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2010
Last Update Date: 05/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11808 HWY 231 431 N
MERIDIANVILLE AL
35759-2126
US

IV. Provider business mailing address

11808 HWY 231 431 N
MERIDIANVILLE AL
35759-2126
US

V. Phone/Fax

Practice location:
  • Phone: 256-828-1500
  • Fax: 256-828-1515
Mailing address:
  • Phone: 256-828-1500
  • Fax: 256-828-1515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License NumberDS4310
License Number StateAL

VIII. Authorized Official

Name: DR. ADA L FRAZIER
Title or Position: OWNER
Credential:
Phone: 256-828-1500