Provider Demographics
NPI:1356489934
Name:SMITH, DEZRIE CELESTINE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEZRIE
Middle Name:CELESTINE
Last Name:SMITH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4814 SILVER HILL RD
Mailing Address - Street 2:
Mailing Address - City:SUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20746-1758
Mailing Address - Country:US
Mailing Address - Phone:301-568-8991
Mailing Address - Fax:301-568-8123
Practice Address - Street 1:4814 SILVER HILL RD
Practice Address - Street 2:
Practice Address - City:SUITLAND
Practice Address - State:MD
Practice Address - Zip Code:20746-1758
Practice Address - Country:US
Practice Address - Phone:301-568-8991
Practice Address - Fax:301-568-8123
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD108971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice