Provider Demographics
NPI:1003005299
Name:DONALD L. SMITHA, DDS, MDS, PA
Entity Type:Organization
Organization Name:DONALD L. SMITHA, DDS, MDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:L
Authorized Official - Last Name:SMITHA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:904-725-8282
Mailing Address - Street 1:812 ALDERMAN RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211-6102
Mailing Address - Country:US
Mailing Address - Phone:904-725-8282
Mailing Address - Fax:904-725-7197
Practice Address - Street 1:812 ALDERMAN RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-6102
Practice Address - Country:US
Practice Address - Phone:904-725-8282
Practice Address - Fax:904-725-7197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 58021223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1215951132OtherNPI NUMBER
K7516OtherMEDICARE OFFICE NUMBER
1215951132OtherNPI NUMBER
FL86023YMedicare PIN