1265520134 NPI number — DR. JAMES DRAYTON SMITH III DMD

Table of content: DR. JAMES DRAYTON SMITH III DMD (NPI 1265520134)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265520134 NPI number — DR. JAMES DRAYTON SMITH III DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
JAMES
Provider Middle Name:
DRAYTON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
DMD
Provider Gender Code:
M

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:
1265520134
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4960 VALLEYDALE ROAD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
HOOVER
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35242
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-991-7350
Provider Business Mailing Address Fax Number:
205-991-7949

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4960 VALLEYDALE ROAD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
HOOVER
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35242
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-991-7350
Provider Business Practice Location Address Fax Number:
205-991-7949
Provider Enumeration Date:
10/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  5024 , 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: 203761528 . This is a "FEIN" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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