Provider Demographics
NPI:1255474334
Name:SMITH, GEORGE ALLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:ALLEN
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 1:6900 ATMORE DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-5644
Mailing Address - Country:US
Mailing Address - Phone:804-674-3578
Mailing Address - Fax:804-674-3551
Practice Address - Street 1:6900 ATMORE DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-5644
Practice Address - Country:US
Practice Address - Phone:804-674-3578
Practice Address - Fax:804-674-3551
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401005233122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist