Provider Demographics
NPI:1730346321
Name:SHOALS SMILE BY DESIGN PC
Entity type:Organization
Organization Name:SHOALS SMILE BY DESIGN PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBBIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:GALLOWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-314-0676
Mailing Address - Street 1:PO BOX 3542
Mailing Address - Street 2:
Mailing Address - City:MUSCLE SHOALS
Mailing Address - State:AL
Mailing Address - Zip Code:35662-3542
Mailing Address - Country:US
Mailing Address - Phone:256-314-0676
Mailing Address - Fax:256-314-6373
Practice Address - Street 1:301 W STATE ST
Practice Address - Street 2:
Practice Address - City:MUSCLE SHOALS
Practice Address - State:AL
Practice Address - Zip Code:35661-2835
Practice Address - Country:US
Practice Address - Phone:256-314-0676
Practice Address - Fax:256-314-6373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4664261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
000764070OtherUNITED CONCORDIA
AL529903880OtherMEDICAID
AL92836OtherBCBS
TN3140572OtherBCBS