Provider Demographics
NPI:1689125213
Name:SMITH, NATALIE R (DDS)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:R
Last Name:SMITH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 WABASHA ST. S
Mailing Address - Street 2:
Mailing Address - City:ST. PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55107-1805
Mailing Address - Country:US
Mailing Address - Phone:651-293-8300
Mailing Address - Fax:651-293-8130
Practice Address - Street 1:406 STEVENS ENTRY
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-4050
Practice Address - Country:US
Practice Address - Phone:770-814-6354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-19
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16028122300000X
GADN1230381223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist