Provider Demographics
NPI:1043419088
Name:SMITH, KEENAN WEBSTER (DMD)
Entity Type:Individual
Prefix:
First Name:KEENAN
Middle Name:WEBSTER
Last Name:SMITH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:463 WOODRUFF RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-3417
Mailing Address - Country:US
Mailing Address - Phone:864-729-8661
Mailing Address - Fax:864-568-5597
Practice Address - Street 1:463 WOODRUFF RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-3417
Practice Address - Country:US
Practice Address - Phone:864-729-8661
Practice Address - Fax:864-568-5597
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC43481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice