Provider Demographics
NPI:1003897281
Name:SMITH, JOHN ALAN (DDS,PC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALAN
Last Name:SMITH
Suffix:
Gender:M
Credentials:DDS,PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1599 FORT HENRY DR
Mailing Address - Street 2:STE. 103
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664-2535
Mailing Address - Country:US
Mailing Address - Phone:423-247-7821
Mailing Address - Fax:423-247-2156
Practice Address - Street 1:1599 FORT HENRY DR
Practice Address - Street 2:STE. 103
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37664-2535
Practice Address - Country:US
Practice Address - Phone:423-247-7821
Practice Address - Fax:423-247-2156
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN74951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice