1326527433 NPI number — SMART DENTAL HOLDINGS, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326527433 NPI number — SMART DENTAL HOLDINGS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SMART DENTAL HOLDINGS, LLC
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:
LUMA DENTISTRY MONTEVALLO
Provider Other Organization Name Type Code:
3
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:
1326527433
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/26/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5751 POCAHONTAS RD STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BESSEMER
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35022-5478
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-477-4242
Provider Business Mailing Address Fax Number:
205-477-4243

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
980 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTEVALLO
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35115-3846
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-665-2031
Provider Business Practice Location Address Fax Number:
205-665-5560
Provider Enumeration Date:
08/09/2018

Additional Information

Authorized Official

Authorized Official Last Name:
KNIGHT
Authorized Official First Name:
CHRISTIE
Authorized Official Middle Name:
Authorized Official Title or Position:
REVENUE CYCLE DIRECTOR
Authorized Official Telephone Number:
205-477-4242

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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