MEDICARE: SAMANTHA S MCCOOL, DMD LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1376379354
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAMANTHA S MCCOOL, DMD LLC

Provider Business Mailing Address
First Line	:	2045 BROOKWOOD MEDICAL CTR DR STE 22
Second Line	:
City	:	HOMEWOOD
State	:	AL
Zip	:	35209-6809
Country	:	US
Telephone Number	:	205-870-9871
Fax Number	:

Provider Business Practice Location Address
First Line	:	2045 BROOKWOOD MEDICAL CTR DR STE 22
Second Line	:
City	:	HOMEWOOD
State	:	AL
Zip	:	35209-6809
Country	:	US
Telephone Number	:	205-870-9871
Fax Number	:

Authorized Official
Title or Position	:	GENERAL DENTIST/OWNER
Name	:	DR. SAMANTHA MCCOOL
Credential	:	DMD
Telephone Number	:	205-310-9179

Provider Enumeration Date	:	09/09/2024
Last Update Date	:	09/09/2024

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