Provider Demographics
NPI:1205842366
Name:SMITH, CAROL CONNER (DMD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:CONNER
Last Name:SMITH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 LARKIN RD
Mailing Address - Street 2:STE.201
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-3256
Mailing Address - Country:US
Mailing Address - Phone:859-278-2931
Mailing Address - Fax:859-278-4448
Practice Address - Street 1:2505 LARKIN RD
Practice Address - Street 2:STE.201
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-3256
Practice Address - Country:US
Practice Address - Phone:859-278-2931
Practice Address - Fax:859-278-4448
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY49921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice