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General NPI Number Information
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NPI Number | 1942710983
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Entity Type | Organization
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Legal Business Name | SOUTHERN DENTAL SLEEP SPECIALISTS LLC
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Dates
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Enumeration Date | 10/04/2017
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Last Update Date | 05/20/2018
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Provider Practice Location Address
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Address Line | 4960 VALLEYDALE RD STE 100
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City | BIRMINGHAM
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State | AL
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Zip | 35242
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Country | US
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Telephone | 205-991-2433
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Fax | 205-380-0623
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Provider Business Mailing Address
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Address Line | 4960 VALLEYDALE RD STE 100
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City | BIRMINGHAM
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State | AL
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Zip | 35242-4613
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Country | US
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Telephone | 205-991-2433
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Fax | 205-380-0623
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAMES DRAYTON SMITH III
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Credential | DMD
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Telephone | 205-991-2433
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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 | 5024
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License Number State | AL
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