Provider Demographics
NPI:1821017872
Name:SMITH, DAVID A (DDS FAGD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:SMITH
Suffix:
Gender:M
Credentials:DDS FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5573 SANDBURG AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122
Mailing Address - Country:US
Mailing Address - Phone:858-450-9222
Mailing Address - Fax:858-453-2110
Practice Address - Street 1:5573 SANDBURG AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122
Practice Address - Country:US
Practice Address - Phone:858-450-9222
Practice Address - Fax:858-453-2110
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17180122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist