Southern Smiles

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

SOUTHERN SMILES

Practice address

2801 John Hawkins Pkwy Ste 175
Hoover, AL 35244-4007

Phone

(205) 988-5858

Fax

(205) 988-5886

NPI assigned

Oct 3, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kelly Graves Guthrie

Title

Dentist

Phone

(205) 988-5858

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Galleria Dental Former legal business name

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1570060800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570060800000",
    "number": "1013558766",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2801 JOHN HAWKINS PKWY STE 175",
            "city": "HOOVER",
            "state": "AL",
            "postal_code": "352444007",
            "telephone_number": "205-988-5858",
            "fax_number": "205-988-5886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 JOHN HAWKINS PKWY STE 175",
            "city": "HOOVER",
            "state": "AL",
            "postal_code": "352444007",
            "telephone_number": "205-988-5858",
            "fax_number": "205-988-5886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN SMILES",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-03",
        "last_updated": "2019-10-03",
        "status": "A",
        "authorized_official_last_name": "GUTHRIE",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "GRAVES",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "205-988-5858"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GENERAL",
            "identifier": "1639579626",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1639579626",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Galleria Dental",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Dentist in Hoover, AL
• Providers in Hoover, AL by specialty
• Dentist in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.