Healthcare Provider Details

I. General information

NPI: 1023275591
Provider Name (Legal Business Name): FOCH M. SMART DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 05/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 RAY THORINGTON RD
MONTGOMERY AL
36117-8486
US

IV. Provider business mailing address

315 RAY THORINGTON RD
MONTGOMERY AL
36117-8486
US

V. Phone/Fax

Practice location:
  • Phone: 334-271-2345
  • Fax:
Mailing address:
  • Phone: 334-271-2345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number4739
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: