Provider Demographics
NPI:1861201543
Name:SMITH FAMILY DENTISTRY LLC
Entity type:Organization
Organization Name:SMITH FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-468-3339
Mailing Address - Street 1:PO BOX 961
Mailing Address - Street 2:
Mailing Address - City:GUIN
Mailing Address - State:AL
Mailing Address - Zip Code:35563-0961
Mailing Address - Country:US
Mailing Address - Phone:205-468-3339
Mailing Address - Fax:205-325-9704
Practice Address - Street 1:161 12TH AVE W STE C
Practice Address - Street 2:
Practice Address - City:GUIN
Practice Address - State:AL
Practice Address - Zip Code:35563-2257
Practice Address - Country:US
Practice Address - Phone:205-468-3339
Practice Address - Fax:205-325-9704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental