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Organization
SOUTHERN SMILES
Active
Organization
SOUTHERN SMILES
Active
Other names
Galleria Dental
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY GRAVES GUTHRIE (DENTIST)
(205) 988-5858
Entity
Organization
Contact information
Practice address
2801 JOHN HAWKINS PKWY STE 175, HOOVER, AL 35244-4007
(205) 988-5858
(205) 988-5886
Mailing address
2801 JOHN HAWKINS PKWY STE 175, HOOVER, AL 35244-4007
(205) 988-5858
(205) 988-5886
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1639579626
GENERAL
FL
05
—
1639579626
—
FL
Enumeration date
10/03/2019
Last updated
10/03/2019
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