Provider Demographics
NPI:1225169485
Name:M.G. SMITH, D.D.S., P.L.C.
Entity Type:Organization
Organization Name:M.G. SMITH, D.D.S., P.L.C.
Other - Org Name:ALEXANDRIA ADVANCED DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-751-7300
Mailing Address - Street 1:4660 KENMORE AVE
Mailing Address - Street 2:SUITE 318
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-1313
Mailing Address - Country:US
Mailing Address - Phone:703-751-7300
Mailing Address - Fax:703-991-0556
Practice Address - Street 1:4660 KENMORE AVE
Practice Address - Street 2:SUITE 318
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-1313
Practice Address - Country:US
Practice Address - Phone:703-751-7300
Practice Address - Fax:703-991-0556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010064381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty