Provider Demographics
NPI:1578555157
Name:SMITH, DEBRA BRADFIELD (DMD)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:BRADFIELD
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 1:5728 WINDSOR WAY
Mailing Address - Street 2:
Mailing Address - City:EASTMAN
Mailing Address - State:GA
Mailing Address - Zip Code:31023-5560
Mailing Address - Country:US
Mailing Address - Phone:478-374-1272
Mailing Address - Fax:478-374-0234
Practice Address - Street 1:1121 PLAZA AVE
Practice Address - Street 2:
Practice Address - City:EASTMAN
Practice Address - State:GA
Practice Address - Zip Code:31023-6761
Practice Address - Country:US
Practice Address - Phone:478-374-5576
Practice Address - Fax:478-374-0234
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA100031223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00297932AMedicaid
GA00297932BMedicaid