Provider Demographics
NPI:1407869043
Name:SMITH, FREDERIC NEWELL (DDS, PHD)
Entity Type:Individual
Prefix:DR
First Name:FREDERIC
Middle Name:NEWELL
Last Name:SMITH
Suffix:
Gender:M
Credentials:DDS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 BERKSHIRE RD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-2629
Mailing Address - Country:US
Mailing Address - Phone:734-662-1198
Mailing Address - Fax:
Practice Address - Street 1:31636 SCHOOLCRAFT RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-1819
Practice Address - Country:US
Practice Address - Phone:734-522-7373
Practice Address - Fax:734-522-2303
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010090951223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics