Provider Demographics
NPI:1790832178
Name:SMART, DAISY (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAISY
Middle Name:
Last Name:SMART
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:DAISY
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:131 MAPLE ROW BLVD STE D402
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-3777
Mailing Address - Country:US
Mailing Address - Phone:615-824-9774
Mailing Address - Fax:
Practice Address - Street 1:131 MAPLE ROW BLVD STE D402
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-3777
Practice Address - Country:US
Practice Address - Phone:615-824-9774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54622122300000X
AK1325122300000X
HICSDT 83122300000X
TNDS119351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1002836Medicaid
HI786543Medicaid