Provider Demographics
NPI:1891811568
Name:SMITH, JAMES C (DMD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:C
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 1:712 LOGAN BLVD
Mailing Address - Street 2:
Mailing Address - City:HOLLIDAYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16648-3015
Mailing Address - Country:US
Mailing Address - Phone:814-946-1950
Mailing Address - Fax:814-946-5725
Practice Address - Street 1:712 LOGAN BLVD
Practice Address - Street 2:
Practice Address - City:HOLLIDAYSBURG
Practice Address - State:PA
Practice Address - Zip Code:16648-3015
Practice Address - Country:US
Practice Address - Phone:814-946-1950
Practice Address - Fax:814-946-5725
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS024665-L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA463335OtherPIN-UCCI
PA1295764868OtherGRP NPI