Provider Demographics
NPI:1164859567
Name:SMITH, SAMUEL IRBY I (DDS, PA)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:IRBY
Last Name:SMITH
Suffix:I
Gender:M
Credentials:DDS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7429
Mailing Address - Street 2:
Mailing Address - City:KILL DEVIL HILLS
Mailing Address - State:NC
Mailing Address - Zip Code:27948-7429
Mailing Address - Country:US
Mailing Address - Phone:252-449-0700
Mailing Address - Fax:
Practice Address - Street 1:1001 S CROATAN HWY
Practice Address - Street 2:
Practice Address - City:KILL DEVIL HILLS
Practice Address - State:NC
Practice Address - Zip Code:27948-8706
Practice Address - Country:US
Practice Address - Phone:252-449-0700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3056122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5910814Medicaid