Provider Demographics
NPI:1083753131
Name:DAVID E SMITH DMD PSC INC
Entity Type:Organization
Organization Name:DAVID E SMITH DMD PSC INC
Other - Org Name:DAVID E SMITH DMD
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:859-887-4008
Mailing Address - Street 1:938 S MAIN ST
Mailing Address - Street 2:PO BOX 277
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40340-0272
Mailing Address - Country:US
Mailing Address - Phone:859-887-4008
Mailing Address - Fax:859-885-6212
Practice Address - Street 1:938 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40340-0272
Practice Address - Country:US
Practice Address - Phone:859-887-4008
Practice Address - Fax:859-885-6212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5425122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty