Provider Demographics
NPI:1891197604
Name:SMITH, MICHAEL SCOTT (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SCOTT
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 1:160 KINGS DAUGHTERS DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-4255
Mailing Address - Country:US
Mailing Address - Phone:502-875-9750
Mailing Address - Fax:502-875-9922
Practice Address - Street 1:160 KINGS DAUGHTERS DR
Practice Address - Street 2:SUITE 100
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-4255
Practice Address - Country:US
Practice Address - Phone:502-875-9750
Practice Address - Fax:502-875-9922
Is Sole Proprietor?:No
Enumeration Date:2014-09-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6431122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist