Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 4739 | AL |
NPI | 1023275591 |
---|---|
Provider Name | Dr. Foch M. Smart |
First Address | Montgomery, AL 36117-8486 |
Second Address | Montgomery, AL 36117-8486 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2008 |
Last Update Date | 21/05/2008 |