Provider Demographics
NPI:1659683324
Name:SMITH, KYLE ALAN (DMD)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:ALAN
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 1:2941 PIEDMONT ROAD N.E. SUITE E
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305
Mailing Address - Country:US
Mailing Address - Phone:404-237-0556
Mailing Address - Fax:404-237-0561
Practice Address - Street 1:2941 PIEDMONT ROAD N.E. SUITE E
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305
Practice Address - Country:US
Practice Address - Phone:404-252-2175
Practice Address - Fax:678-735-3148
Is Sole Proprietor?:No
Enumeration Date:2010-07-09
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN014133122300000X, 1223G0001X
SC6908122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist