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General NPI Number Information
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NPI Number | 1770011082
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Entity Type | Organization
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Legal Business Name | DESIGNER SMILES OF AL, INC.
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Dates
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Enumeration Date | 05/31/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 90 LARRY GARDNER DR
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City | ANNISTON
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State | AL
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Zip | 36207-3401
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Country | US
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Telephone | 256-237-1537
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Fax |
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Provider Business Mailing Address
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Address Line | 90 LARRY GARDNER DR
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City | ANNISTON
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State | AL
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Zip | 36207-3401
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Country | US
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Telephone | 256-237-1537
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Fax |
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Authorized Official
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Title or Position | DOCTOR/ OWNER
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Name | DR. JORDAN BARRY BENTON
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Credential | DMD, MSD
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Telephone | 256-239-5406
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 0006122-C
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License Number State | AL
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