Provider Demographics
NPI:1104858778
Name:SMITH, CONSTANCE ELIZABETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:CONSTANCE
Middle Name:ELIZABETH
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 1:1931 HORTON RD
Mailing Address - Street 2:SUITE #14
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-5594
Mailing Address - Country:US
Mailing Address - Phone:517-787-7520
Mailing Address - Fax:517-787-2575
Practice Address - Street 1:1931 HORTON RD
Practice Address - Street 2:SUITE #14
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-5594
Practice Address - Country:US
Practice Address - Phone:517-787-7520
Practice Address - Fax:517-787-2575
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901012155122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist