Provider Demographics
NPI:1518018134
Name:SMITH, JEWEL BERNADETTE (DDS)
Entity Type:Individual
Prefix:MRS
First Name:JEWEL
Middle Name:BERNADETTE
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 1:2880 OLD JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:GA
Mailing Address - Zip Code:30248-2756
Mailing Address - Country:US
Mailing Address - Phone:678-205-7185
Mailing Address - Fax:
Practice Address - Street 1:2880 OLD JACKSON RD
Practice Address - Street 2:
Practice Address - City:LOCUST GROVE
Practice Address - State:GA
Practice Address - Zip Code:30248-2756
Practice Address - Country:US
Practice Address - Phone:678-205-7185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0122081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice