Provider Demographics
NPI:1699043836
Name:SMITH, DAVID EDWIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:EDWIN
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 1:938 SOUTH MAIN STREET
Mailing Address - Street 2:PO BOX 277
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40340-0272
Mailing Address - Country:US
Mailing Address - Phone:859-887-4008
Mailing Address - Fax:859-885-6212
Practice Address - Street 1:938 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-0272
Practice Address - Country:US
Practice Address - Phone:859-887-4008
Practice Address - Fax:859-885-6212
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY54251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice