Provider Demographics
NPI:1760654560
Name:SMITHIE, PAMELA SUE (DMD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:SUE
Last Name:SMITHIE
Suffix:
Gender:F
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:PO BOX 990
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:MS
Mailing Address - Zip Code:39666-0990
Mailing Address - Country:US
Mailing Address - Phone:601-684-5150
Mailing Address - Fax:
Practice Address - Street 1:1064 HIGHWAY 51
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-8769
Practice Address - Country:US
Practice Address - Phone:601-684-5150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3015-97122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00660240Medicaid