Provider Demographics
NPI:1619753357
Name:SMALLWOOD, DEMMI (RDH)
Entity Type:Individual
Prefix:
First Name:DEMMI
Middle Name:
Last Name:SMALLWOOD
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 598
Mailing Address - Street 2:
Mailing Address - City:CRAIGSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26205-0598
Mailing Address - Country:US
Mailing Address - Phone:304-516-2841
Mailing Address - Fax:
Practice Address - Street 1:390 INDUSTRIAL PARK RD
Practice Address - Street 2:
Practice Address - City:MAXWELTON
Practice Address - State:WV
Practice Address - Zip Code:24957-8073
Practice Address - Country:US
Practice Address - Phone:681-318-3611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3510124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist