1881861631 NPI number — SMILES FROM US, PLLC

Table of content: (NPI 1881861631)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881861631 NPI number — SMILES FROM US, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SMILES FROM US, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881861631
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/01/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2600 BELL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTGOMERY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36117-4375
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-358-6411
Provider Business Mailing Address Fax Number:
334-351-0033

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2600 BELL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTGOMERY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36117-4375
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-358-6411
Provider Business Practice Location Address Fax Number:
334-351-0033
Provider Enumeration Date:
05/12/2008

Additional Information

Authorized Official

Authorized Official Last Name:
STANLEY
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
DENTIST/VICE PRESIDENT
Authorized Official Telephone Number:
334-358-6411

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X , with the licence number:  2865 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223P0221X , with the licence number: 4869 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223P0221X , with the licence number: 5053 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223P0221X , with the licence number: 5221 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223P0221X , with the licence number: 5199 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 515-23254 . This is a "BLUE CROSS BLUE SHIELD OF ALABAMA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 515-25517 . This is a "BLUE CROSS BLUE SHIELD OF ALABAMA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 515-28153 . This is a "BLUE CROSS BLUE SHIELD OF ALABAMA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 009965115 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 515-19534 . This is a "BLUE CROSS BLUE SHIELD OF ALABAMA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 510-60720 . This is a "BLUE CROSS BLUE SHIELD OF ALABAMA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 770948 . This is a "UNITED CONCORDIA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 515-23250 . This is a "BLUE CROSS BLUE SHIELD OF ALABAMA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 515-25362 . This is a "BLUE CROSS BLUE SHIELD OF ALABAMA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 515-23249 . This is a "BLUE CROSS BLUE SHIELD OF ALABAMA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 515-28152 . This is a "BLUE CROSS BLUE SHIELD OF ALABAMA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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