Provider Demographics
NPI:1891156048
Name:SMITH, PAYTON DANE (DMD)
Entity Type:Individual
Prefix:DR
First Name:PAYTON
Middle Name:DANE
Last Name:SMITH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:PATE
Other - Middle Name:DANE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:19 LAKEMONT DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-3133
Mailing Address - Country:US
Mailing Address - Phone:478-391-9723
Mailing Address - Fax:
Practice Address - Street 1:19 LAKEMONT DR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-3133
Practice Address - Country:US
Practice Address - Phone:478-391-9723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-16
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program