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General NPI Number Information
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NPI Number | 1861201543
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Entity Type | Organization
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Legal Business Name | SMITH FAMILY DENTISTRY LLC
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Dates
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Enumeration Date | 01/06/2025
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Last Update Date | 01/06/2025
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Provider Practice Location Address
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Address Line | 161 12TH AVE W STE C
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City | GUIN
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State | AL
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Zip | 35563-2257
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Country | US
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Telephone | 205-468-3339
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Fax | 205-325-9704
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Provider Business Mailing Address
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Address Line | PO BOX 961
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City | GUIN
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State | AL
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Zip | 35563-0961
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Country | US
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Telephone | 205-468-3339
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Fax | 205-325-9704
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. JORDAN SMITH
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Credential | DMD
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Telephone | 205-468-3339
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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