NPIMap

Organization Active NPI

LD-Northport, LLC

  • Dental Clinic/Center
  • Tuscaloosa, AL
National Provider Identifier
1114634730
Registry record updated Jul 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
LD-NORTHPORT, LLC
Doing business as
North River Dental
Practice address
1100 Fairfax Park
Tuscaloosa, AL 35406-2809
Phone
(205) 752-3506
Fax
(205) 752-3570
NPI assigned
Nov 2, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2023

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

Authorized official

Name
Lauren S Daigneault, BA, MA
Title
Admin Director
Phone
(256) 783-9468

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

1100 Fairfax Park
Tuscaloosa, AL 35406-2809

Mailing address

1100 Fairfax Park
Tuscaloosa, AL 35406-2809
Phone (205) 752-3506

Other names 3

  • North River Dental Doing business as
  • Jack Smalley, JR., D.M.D., P.C. Former legal business name
  • North River Dental Associates, P.C. Former legal business name

National Provider Directory

National Provider Directory

Locations

1100 Fairfax Park
Ofc Park
Tuscaloosa, AL 35406

1100 Fairfax Park
Tuscaloosa, AL 35406
Phone (205) 752-3506

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1667347200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688342400000",
    "number": "1114634730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 FAIRFAX PARK",
            "city": "TUSCALOOSA",
            "state": "AL",
            "postal_code": "354062809",
            "telephone_number": "205-752-3506",
            "fax_number": "205-752-3570"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 FAIRFAX PARK",
            "city": "TUSCALOOSA",
            "state": "AL",
            "postal_code": "354062809",
            "telephone_number": "205-752-3506",
            "fax_number": "205-752-3570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LD-NORTHPORT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-02",
        "last_updated": "2023-07-03",
        "certification_date": "2023-07-03",
        "status": "A",
        "authorized_official_last_name": "DAIGNEAULT",
        "authorized_official_first_name": "LAUREN",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "ADMIN DIRECTOR",
        "authorized_official_telephone_number": "256-783-9468",
        "authorized_official_credential": "BA, MA"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "North River Dental",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Jack Smalley, JR., D.M.D., P.C.",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "North River Dental Associates, P.C.",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "North River Dental Associates, P.C.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Tuscaloosa, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2023; 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.