Provider Demographics
NPI:1497140636
Name:SMITH, MARY AUSTIN MAYS (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARY AUSTIN
Middle Name:MAYS
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 1:6565 STAGE RD STE 2
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38134-3830
Mailing Address - Country:US
Mailing Address - Phone:901-382-0280
Mailing Address - Fax:
Practice Address - Street 1:6565 STAGE RD STE 2
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-3830
Practice Address - Country:US
Practice Address - Phone:901-382-0280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-04
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS0000009904122300000X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ037361Medicaid