Provider Demographics
NPI:1639221708
Name:SMITH, PAUL ANDREW (DMD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ANDREW
Last Name:SMITH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 EAGLES LANDING PKWY
Mailing Address - Street 2:SUITE420
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7247
Mailing Address - Country:US
Mailing Address - Phone:770-507-8010
Mailing Address - Fax:770-507-4052
Practice Address - Street 1:909 EAGLES LANDING PKWY
Practice Address - Street 2:SUITE420
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7247
Practice Address - Country:US
Practice Address - Phone:770-507-8010
Practice Address - Fax:770-507-4052
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA109341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice