Organization
MONTGOMERY SMILES YOUTH DENTISTRY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JENELL STUMP (MANAGER, LICENSING & CREDENTIALING)
(615) 750-0343
Entity
Organization
Contact information
Practice address
3439 MCGEHEE RD, SUITE B, MONTGOMERY, AL 36111-3392
(334) 228-1868
(334) 288-1825
Mailing address
16 ARCADE UNIT 198747, NASHVILLE, TN 37219-1994
(615) 750-0343
(615) 986-1705
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
529930610
—
AL
Enumeration date
11/13/2006
Last updated
07/09/2014
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