Provider Demographics
NPI:1437306479
Name:SMITH, LORI LANDRENEAU (DDS)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:LANDRENEAU
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 1:4706 WOODSTOCK RD
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-2091
Mailing Address - Country:US
Mailing Address - Phone:770-992-6122
Mailing Address - Fax:770-993-5385
Practice Address - Street 1:4706 WOODSTOCK RD
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-2091
Practice Address - Country:US
Practice Address - Phone:770-992-6122
Practice Address - Fax:770-993-5385
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA106911223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics