Provider Demographics
NPI:1679911606
Name:SMITH, JONATHAN S (DDS)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:S
Last Name:SMITH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 S LEEDS AVE
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36612-1946
Mailing Address - Country:US
Mailing Address - Phone:251-786-2011
Mailing Address - Fax:
Practice Address - Street 1:720 S LEEDS AVE
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36612-1946
Practice Address - Country:US
Practice Address - Phone:251-786-2011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5989 C1122300000X
TX290831223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist