Provider Demographics
NPI:1235160169
Name:SMITH, JON D (DDS)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:D
Last Name:SMITH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 CHARTER OAK RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-9710
Mailing Address - Country:US
Mailing Address - Phone:803-359-6143
Mailing Address - Fax:803-359-6140
Practice Address - Street 1:110 CHARTER OAK RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-9710
Practice Address - Country:US
Practice Address - Phone:803-359-6143
Practice Address - Fax:803-359-6140
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC34741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice