Provider Demographics
NPI:1467658021
Name:SMITH, ALFRED E SR (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:E
Last Name:SMITH
Suffix:SR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13301 CANTERBURY DR
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-2650
Mailing Address - Country:US
Mailing Address - Phone:301-797-7273
Mailing Address - Fax:301-797-2987
Practice Address - Street 1:19418 LEITERSBURG PIKE
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-1438
Practice Address - Country:US
Practice Address - Phone:301-797-8987
Practice Address - Fax:301-797-9025
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD052401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice