Provider Demographics
NPI:1164872057
Name:SMITH, DAVIS (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVIS
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2627 PEACHTREE PKWY STE 440
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-1018
Mailing Address - Country:US
Mailing Address - Phone:770-888-3384
Mailing Address - Fax:
Practice Address - Street 1:2627 PEACHTREE PKWY STE 440
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-1018
Practice Address - Country:US
Practice Address - Phone:770-888-3384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0151711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice