Provider Demographics
NPI:1033279534
Name:SMITH, MAURICE EDWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:MAURICE
Middle Name:EDWARD
Last Name:SMITH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3870 PEACHTREE INDUSTRIAL BLVD
Mailing Address - Street 2:#230
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-1422
Mailing Address - Country:US
Mailing Address - Phone:770-476-9004
Mailing Address - Fax:
Practice Address - Street 1:3870 PEACHTREE INDUSTRIAL BLVD
Practice Address - Street 2:#220
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-1422
Practice Address - Country:US
Practice Address - Phone:770-476-9004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1019151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice