Provider Demographics
NPI:1659300077
Name:SMITH, DAVID HOWARD (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:HOWARD
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 1:3038 BRECKENRIDGE LN
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-2195
Mailing Address - Country:US
Mailing Address - Phone:502-499-2032
Mailing Address - Fax:502-493-9865
Practice Address - Street 1:3038 BRECKENRIDGE LN
Practice Address - Street 2:SUITE 103
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-2195
Practice Address - Country:US
Practice Address - Phone:502-499-2032
Practice Address - Fax:502-493-9865
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY56221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice