Provider Demographics
NPI:1144231978
Name:MICHAEL L SMITH DDS INC
Entity Type:Organization
Organization Name:MICHAEL L SMITH DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LAWSON
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-253-4473
Mailing Address - Street 1:PO BOX 1446
Mailing Address - Street 2:1271 ROBERT C BYRD DR
Mailing Address - City:CRAB ORCHARD
Mailing Address - State:WV
Mailing Address - Zip Code:25827-1446
Mailing Address - Country:US
Mailing Address - Phone:304-253-4473
Mailing Address - Fax:304-253-1939
Practice Address - Street 1:1271 ROBERT C BYRD DR
Practice Address - Street 2:
Practice Address - City:CRAB ORCHARD
Practice Address - State:WV
Practice Address - Zip Code:25827-1446
Practice Address - Country:US
Practice Address - Phone:304-253-4473
Practice Address - Fax:304-253-1939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3092122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty