MEDICARE: SMART DENTAL HOLDINGS, 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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1891354841
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMART DENTAL HOLDINGS, LLC

Provider Business Mailing Address
First Line	:	5751 POCAHONTAS RD
Second Line	:
City	:	BESSEMER
State	:	AL
Zip	:	35022-5476
Country	:	US
Telephone Number	:	205-477-4242
Fax Number	:	205-477-4243

Provider Business Practice Location Address
First Line	:	5751 POCAHONTAS RD
Second Line	:
City	:	BESSEMER
State	:	AL
Zip	:	35022-5476
Country	:	US
Telephone Number	:	205-477-4242
Fax Number	:	205-477-4243

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. KELLIE HOBSON
Credential	:
Telephone Number	:	205-477-4242

Provider Enumeration Date	:	06/12/2019
Last Update Date	:	06/12/2019

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Directions to “SMART DENTAL HOLDINGS, LLC ” Practice Location

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