Provider Demographics
NPI:1003147000
Name:SMITH ORTHODONTICS
Entity Type:Organization
Organization Name:SMITH ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:DEMPSEY
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:919-563-4746
Mailing Address - Street 1:1941 HIGHWAY 119 SOUTH
Mailing Address - Street 2:
Mailing Address - City:MEBANE
Mailing Address - State:NC
Mailing Address - Zip Code:27302
Mailing Address - Country:US
Mailing Address - Phone:919-563-4746
Mailing Address - Fax:
Practice Address - Street 1:1941 S. HWY. 119
Practice Address - Street 2:
Practice Address - City:MEBANE
Practice Address - State:NC
Practice Address - Zip Code:23702
Practice Address - Country:US
Practice Address - Phone:919-563-4746
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC73291223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty