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General NPI Number Information
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NPI Number | 1336565449
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Entity Type | Organization
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Legal Business Name | SUNNY SMILES DENTAL CENTER, LLC
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Dates
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Enumeration Date | 03/13/2014
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Last Update Date | 03/13/2014
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Provider Practice Location Address
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Address Line | 401 LOWELL DR SE SUITE 17
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City | HUNTSVILLE
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State | AL
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Zip | 35801-3748
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Country | US
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Telephone | 256-533-0434
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Fax | 256-533-2682
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Provider Business Mailing Address
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Address Line | PO BOX 18785
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City | HUNTSVILLE
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State | AL
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Zip | 35804-8785
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Country | US
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Telephone | 256-533-0434
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Fax | 256-533-2682
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. JOHN STALLENS
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Credential | DDS
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Telephone | 256-533-0434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 4962
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License Number State | AL
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