Organization
LD-NORTHPORT, LLC
Active
Other names
Jack Smalley, JR., D.M.D., P.C., North River Dental Associates, P.C., North River Dental
Organization subpart
No
Provider details
NPI number
Authorized official
LAUREN S DAIGNEAULT BA, MA (ADMIN DIRECTOR)
(256) 783-9468
Entity
Organization
Contact information
Practice address
1100 FAIRFAX PARK, TUSCALOOSA, AL 35406-2809
(205) 752-3506
(205) 752-3570
Mailing address
1100 FAIRFAX PARK, TUSCALOOSA, AL 35406-2809
(205) 752-3506
(205) 752-3570
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
11/02/2022
Last updated
07/03/2023
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