Provider Demographics
NPI:1427184225
Name:SMITH, SCOTT (DDS)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:
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 1:2290 E HILL RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-5423
Mailing Address - Country:US
Mailing Address - Phone:810-694-0120
Mailing Address - Fax:810-694-1882
Practice Address - Street 1:2290 E HILL RD
Practice Address - Street 2:SUITE 201
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-5423
Practice Address - Country:US
Practice Address - Phone:810-694-0120
Practice Address - Fax:810-694-1882
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901013514122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist