Provider Demographics
NPI:1598157315
Name:SMITH DENTAL CARE
Entity Type:Organization
Organization Name:SMITH DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:MELVIN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:706-376-2345
Mailing Address - Street 1:259 ATHENS ST
Mailing Address - Street 2:
Mailing Address - City:HARTWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30643-1854
Mailing Address - Country:US
Mailing Address - Phone:706-376-2345
Mailing Address - Fax:706-376-7244
Practice Address - Street 1:259 ATHENS ST
Practice Address - Street 2:
Practice Address - City:HARTWELL
Practice Address - State:GA
Practice Address - Zip Code:30643-1854
Practice Address - Country:US
Practice Address - Phone:706-376-2345
Practice Address - Fax:706-376-7244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-03
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11202122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty