=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780029801
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SMITH AND BAILEY DENTAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/02/2013
-----------------------------------------------------
Last Update Date | 05/02/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3343 RAINBOW DR
-----------------------------------------------------
City | RAINBOW CITY
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35906-6201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-456-5936
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3343 RAINBOW DR
-----------------------------------------------------
City | RAINBOW CITY
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35906-6201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-456-5936
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | DR. JULIE G SMITH
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 256-456-5936
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 5703
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------