Provider Demographics
NPI:1366458432
Name:SMITH, KARL DEREK (DDS)
Entity Type:Individual
Prefix:DR
First Name:KARL
Middle Name:DEREK
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 1:1033 OBERLIN RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27605-1199
Mailing Address - Country:US
Mailing Address - Phone:919-834-2362
Mailing Address - Fax:919-828-0008
Practice Address - Street 1:1033 OBERLIN RD
Practice Address - Street 2:SUITE 120
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27605-1199
Practice Address - Country:US
Practice Address - Phone:919-834-2362
Practice Address - Fax:919-828-0008
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
NC58491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCU60696Medicare UPIN