Provider Demographics
NPI:1790947851
Name:SMITH, CLEVELAND TRAMMELL (DMD)
Entity Type:Individual
Prefix:DR
First Name:CLEVELAND
Middle Name:TRAMMELL
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 1:1701 SAINT JULIAN PL
Mailing Address - Street 2:SUITE 204
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-2418
Mailing Address - Country:US
Mailing Address - Phone:803-771-6393
Mailing Address - Fax:
Practice Address - Street 1:1701 SAINT JULIAN PL
Practice Address - Street 2:SUITE204
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2418
Practice Address - Country:US
Practice Address - Phone:803-771-6393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2827122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist