Provider Demographics
NPI:1497275226
Name:SMITH, KATELYN R (DMD)
Entity Type:Individual
Prefix:DR
First Name:KATELYN
Middle Name:R
Last Name:SMITH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3973 ATLANTA HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-3750
Mailing Address - Country:US
Mailing Address - Phone:770-466-3114
Mailing Address - Fax:770-466-3777
Practice Address - Street 1:3973 ATLANTA HWY STE 100
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-3750
Practice Address - Country:US
Practice Address - Phone:770-466-3114
Practice Address - Fax:770-466-3777
Is Sole Proprietor?:No
Enumeration Date:2017-06-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0154501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice