Provider Demographics
NPI:1043477417
Name:SMITH, STEPHANIE CONSTANCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:CONSTANCE
Last Name:SMITH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4221 VIRGINIA BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-1207
Mailing Address - Country:US
Mailing Address - Phone:757-486-3919
Mailing Address - Fax:757-486-8792
Practice Address - Street 1:4221 VIRGINIA BEACH BLVD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-1207
Practice Address - Country:US
Practice Address - Phone:757-486-3919
Practice Address - Fax:757-486-8792
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014106011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice